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AWANA Club Registration Form
This form must be fully completed for each child attending club.
*
Indicates required field
Child's First Name
*
Child's Last Name
*
Street Address
*
City
*
Zip Code
*
Home Phone
*
Cell Phone
*
Email
*
Home Church
*
Grade
*
Choose one:
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Age (must be 3 by Sept. 1)
*
Choose one:
3
4
5
6
7
8
9
10
11
12
Gender
*
Male
Female
Date of Birth (MM/DD/YY)
*
Medical Information
Parent/Legal Guardian Name
*
Allergies, Illnesses, Other Conditions or type "None"
*
Insurance Carrier and ID#
*
Emergency Contact Name
*
Emergency Contact Phone
*
Photo, Press, Audio & Electronic Media Release for Minors
*
I, being Parent/Guardian consent that his/her name, image, and likeness, as shown in the CDs, videotapes, photographs, motion picture film and/or electronic images for which they posed or appeared, and/or audio recordings made of their voice may be used by Calvary Baptist Church Awana Club, its assigns or successors, in whatever way they desire, including television; furthermore, I consent that such video-tapes, photographs, motion picture films, electronic images, recordings, and the plates, tapes and/or software ("property") from which they are made shall be the sole property of the Calvary Baptist Church Awana Club, its assigns or successors. I further agree that use of his/her name, image, and likeness will not result in an invasion of his/her privacy or a violation of any property rights, and they shall have the right to sell, duplicate, reproduce and make other uses of such property as they may desire free and clear of any claim whatsoever on my part, individually, my marital community, or on the part of the minor on whose behalf I am signing this Release.
Signature
*
By pressing the register button below, I understand that I am electronically registering my child on today's date, and that I will be asked to sign this form in person on the first day of AWANA.
Medical and Liability Release
*
As a parent and/or guardian, I do authorize treatment, under the direction of any licensed physician, for the above named minor in the event of a medical emergency, which in the opinion of the attending physician, would endanger his or her life. This authority is granted only after a reasonable effort has been made to reach me by phone at the number(s) listed above. I (we) are the parent(s) or legal guardian(s) of this participant, do release, forever discharge and agree to hold harmless Calvary Baptist Church AWANA Club and the directors/workers/volunteers thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the child participant that occur while said is participating in the Calvary Baptist Church Awana Club trips or activities. Furthermore, I on behalf of my child participant, assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is given to Calvary Baptist Church Awana Club and the undersigned further agrees to hold harmless and indemnify Calvary Baptist Church Awana Club, its directors, staff and volunteers, for any liability sustained by said travel organizers as the result of negligent, willful or intentional acts of said participant, including expenses incurred.
REGISTER
Home
Worship
Calendar
About
Mission, Vision, Core Values
Staff & Deacons
Connect
AWANA Clubs
AWANA Registration
Children
>
Kids Night Out
Food Fight
VBS
Youth
>
Sunday Bible Study
Summer Camp
Bible Studies
Women
Men
Missions & Outreach
Music
Prayer
Upcoming Events
FAQ
Contact Us
Weekly Sermons
Photo Gallery