Kids' Night Out with Awana - Shady Grove Church
Proverbs 22:6 Train up a child in the way he should go: and when he is old, he will not depart from it.
Clubber's Name (first and last)
Clubber Resides with:
Both Mom & Dad
Mom's Cell (XXX-XXX-XXXX)
Dad's Cell (XXX-XXX-XXXX)
Clubber's Date of Birth
If your child has not yet completed Kindergarten, what year will they enter?
My child has already completed Kindergarten
Newborn to 2-years-old
Clubber's T-Shirt Size:
Youth XS (4-5)
Youth S (6-8)
Youth M (10-12)
Youth L (14-16)
Youth XL (18-20)
Any Food Allergies?
Does the clubber have any medical issues?
Any activity Clubber should not participate in?
Emergency Contact if Dad/Mom are not reachable (name and number)
I understand and acknowledge that my child will be playing games while at Kids Night Out at Shady Grove Church and that any physical activity can pose a risk of injury. I fully accept the risk and hold harmless Shady Grove Church and any and all persons involved in the Kids Night Out ministry at Shady Grove Church from any legal liability. Confirmed and acknowledged by choosing yes.
In the event of an emergency that requires the medical treatment of my child, I understand that every effort will be made to contact me or the emergency contact listed. However, if I/we cannot be reached, I give permission to Shady Grove Church and the Kids Night Out volunteers to secure the services of medical professionals to provide any necessary medical care for my child's well being and I assume responsibility for any cost associated with same. Confirmed and acknowledged by choosing yes.
I understand that photo(s) of my child may appear among other general Kids Night Out photos that are used for promotion by Shady Grove Church.
Registration fees for this year are $20 per child. I acknowledge these fees which are solely utilized for purchase of Clubber materials such as handbook, bags, etc.
Registration fees are acknowledged and I will hand-deliver to Daniel Osborne as promptly as possible after registration.
I have read and accept the above terms and conditions and wish for my child to participate in Kids Night Out at Shady Grove Church.
Please sign your name electronically to confirm.
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