2023-2024 Awana Registration Form

Family Information

Address

Mother’s/Guardian’s Name

Mother’s/Guardian’s Email

This address will receive a confirmation email

Mother’s/Guardian’s Phone

Father’s/Guardian’s Name

Father’s/Guardian’s Email

This address will receive a confirmation email

Father’s/Guardian’s Phone

Emergency Contact Information (Please provide a phone number for each person listed.)

Adults (18 or older) Authorized to pick up your child(ren). Please provide phone numbers. For the security of your child(ren), we will require a photo ID if we do not recognize them.

Child 1 Information

Child 1 Name

Child 1 Birthday

Child 1 Age/Grade (starting Fall 2023)

Child 1 Medical Concerns and/or Allergies (Please explain any details.)

Child 2 Information

If only registering one child, please input N/A in the remaining fields.

Child 2 Name

Child 2 Birthday

Child 2 Age/Grade (starting Fall 2023)

Child 2 Medical Concerns and/or Allergies (Please explain any details.)

Child 3 Information

If only registering two children, please input N/A in the remaining fields.

Child 3 Name

Child 3 Birthday

Child 3 Age/Grade (starting Fall 2023)

Child 3 Medical Concerns and/or Allergies (Please explain any details.)

Child 4 Information

If only registering three children, please input N/A in the remaining fields.

Child 4 Name

Child 4 Birthday

Child 4 Age/Grade (starting Fall 2023)

Child 4 Medical Concerns and/or Allergies (Please explain any details.)

Waiver

In consideration of your child being allowed to participate in the above event, you, as the parent or guardian: consent to the child's participation; certify the child is physically and emotionally able to participate; understand the event is a Christian event conducted and governed by principles and values in accordance with the Bible and the church's statement of faith, which is available for your review prior to signing; authorize the church to make emergency medical decisions on behalf of your child in the event you cannot be contacted; release and identify the church, it's pastors, officers employees and volunteers from any and all liability for injury, loss or damage to the person or property of your child except in the event of an intentional act, gross negligence or willful and wanton conduct by such person.

I agree to the above:

2023-2024 Awana Registration Form

Description

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