AWANA Clubber Registration
Please complete and sign this form. Club Year: 2021-2022 **Book, uniform, and dues are waived this year!
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Parent/Guardian Name *
Parent/Guardian Name Address *
Parent/Guardian City/State/Zip *
Parent/Guardian Cell Phone/contact person *
Do we have permission to text you? *
Required
If you grant permission for us to send text messages, please provide your cell phone carrier's name here: (e.g. AT&T, Verizon, etc.)
Work phone /contact person *
Emergency contact name and number during club time (other than parents) *
Parent/Guardian Email *
Home Church *
Persons (other than parents) authorized to pick up the children *
Child #1 First and Last Name *
Child #1 Birth Date *
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Child #1 Gender *
Child #1 Grade *
Child #1 School *
Child #1 Allergies/Medicine/Special Needs (If you have more than one child registered, please denote which clubber has the allergy, meds or special needs so that we can convey this to their leader.) *
Does child #1 need a book or uniform? *
Required
CHILD #2
Please enter all information below for child #2 if applicable.
Child #2 First and Last Name
Child #2 Birth Date
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DD
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YYYY
Child #2 Gender
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Child #2 Grade
Child #2 Allergies/Medicine/Special Needs (If you have more than one child registered, please denote which clubber has the allergy, meds or special needs so that we can convey this to their leader.)
Child #2 School
Does child #2 need a book or uniform?
CHILD #3
Please enter all information below for child #3 if applicable.
Child #3 First and Last Name
Child #3 Birth Date
MM
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DD
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YYYY
Child #3 Gender
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Child #3 Grade
Child #3 School
Child #3 Allergies/Medicine/Special Needs (If you have more than one child registered, please denote which clubber has the allergy, meds or special needs so that we can convey this to their leader.)
Does child #3 need a book or uniform?
TERMS AND CONDITIONS: 1. I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Calvary Baptist Church and in persons involved in the Awana Club Ministry. 2. In the event of an emergency that requires medical treatment for the above name child/children, I understand every effort will be made to contact me or my emergency contacts. However, if I/we cannot be reached, I give my permission to the Awana volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child. 3. I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information shown. 4. I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand. By typing my name below I certify that I have read and agree to the Terms and Conditions stated above. I understand this will act as a written signature. **We will still need a physical signature when you drop your child/children off at Calvary *
Today's Date *
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I am interested in helping:
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Every other week
Monthly
For Special Events
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