Awana Regular Registration 2019

Please Complete Parent/Guardian Information

Mother's First Name

Mother's Phone

Mother's Email

This address will receive a confirmation email

Father's First Name

Father's Last Name

This address will receive a confirmation email

Father's Phone

Address

I am interested in serving in AWANA, please contact me.

Yes No

Please contact this person if parent/guardian cannot be reached.

Name

Mobile Phone

Relationship to Child

Please read the following Waiver of Liability and Medical Release and Photo/Video Release.

WAIVER OF LIABILITY AND MEDICAL RELEASE - I agree and consent to having the adult leaders of AWANA, under whose auspices this program is conducted, approved as guardian to secure any emergency medical care or treatment that may be necessary for all children during AWANA meetings and activities. I further assume all responsibility for their decisions so made, and the emergency care or treatment so secured by them. I also release Amity Bible Church, and all AWANA leaders, from any, and all liability, claims, suits, demands, or causes of action which may arise from bodily injury or property damage as a result of said party’s participation in or observation of the above stated activities.

Do you consent to the Waiver of Liability and Medical Release?

No Yes

PHOTO/VIDEO RELEASE - I understand that photos and videos of my child/children may be taken at these activities for publication. I waive any claim for damages against Amity Bible Church or its representatives from unconsented use, altering or republication of my child’s image by third parties accessing the Internet/WorldWideWeb. If my desires change or any changes to this form need to be made, it is my responsibility to notify Amity Bible Church in writing of these changes.

Do you consent to the Photo/Video Release?

No Yes

I wish to donate to AWANA 2019/2020.

REGISTERING YOUR CHILD/CHILDREN FOR AWANA

Welcome to AWANA at Amity! We are so excited that you have elected to invest in your child(ren)'s spiritual development through the AWANA program. At Amity, our program serves children from age 3 through 12th grade.

Uniforms - If your child(ren) is/are new to the program or has/have advanced to the next Club [level] since last school year, then your child(ren) will receive a uniform and a handbook.

Handbooks - New handbooks are provided for Clubbers who are new to AWANA or their Club and/or they completed the handbook last school year.

Snacks - A light meal will be provided before Club begins each night of the program.

Registration fee - Due to the costs associated with the AWANA program, celebrations, recognition, and special events, Clubbers' registration fees help to offset some of those costs.

Bags - Bags are not required, but may be purchased for Clubbers at the costs noted below.

Registration Fee $75

Optional handbook bags are additional cost.

Child 1 - First and Last Name

Child 1 - Gender

Boy Girl

Child 1 - Date of Birth (format 04/10/2002)

Child 1 - 2018/2019 School Grade (ex: 3rd)

Child 1 - List any allergies (or type 'none')

ENTER INFORMATION FOR CHILD #2

Registration Fee

Optional handbook bags are available at an additional cost.

Child 2 - First and Last Name

Child 2 - Gender

Boy Girl

Child 2 - Date of Birth (format 04/10/2002)

Child 2 - 2018/2019 School Grade (ex: 3rd)

Child 2 - List any allergies (or type 'none')

ENTER INFORMATION FOR CHILD #3

Registration Fee

Optional handbook bags are available at an additional cost.

Child 3 - First and Last Name

Child 3 - Gender Boy Girl

Child 3 - Date of Birth (format 04/10/2002)

Child 3 - 2018/2019 School Grade (ex: 3rd)

Child 3 - List any allergies (or type 'none')

ENTER INFORMATION FOR CHILD #4

Registration Fee

Optional handbook bags are available at an additional cost.

Child 4 - First and Last Name

Child 4 - Gender Boy Girl

Child 4 - Date of Birth (format 04/10/2002)

Child 4 - 2018/2019 School Grade (ex: 3rd)

Child 4 - List any allergies (or type 'none')

ENTER INFORMATION FOR CHILD #5

Registration Fee

Optional handbook bags are available at an additional cost.

Child 5 - First and Last Name

Child 5 - Gender Boy Girl

Child 5 - Date of Birth (format 04/10/2002)

Child 5 - 2018/2019 School Grade (ex: 3rd)

Child 5 - List any allergies (or type 'none')

Optional Handbook Bags are an Additional Cost.

Please note that vests/shirts will only be required/ordered for Clubbers who are advancing to a new Club this year.

Please use this space for additional information or questions.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Awana Regular Registration 2019

Description

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