Awana Regular Registration 2022/2023

Please Complete Parent/Guardian Information

Mother's Name

Mother's Phone

Mother's Email

This address will receive a confirmation email

Father's First Name

Father's Last Name

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 2022/2023

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. Clubbers' registration fees help to offset some of the costs of books, award recognition and special events.

Registration Fee $50

Child 1 - First and Last Name

Child 1 - Gender

Boy Girl

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

Child 1 - 2022/2023 School Grade (ex: 3rd)

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

ENTER INFORMATION FOR CHILD #2

Registration Fee

Child 2 - First and Last Name

Child 2 - Gender Boy Girl

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

Child 2 - 2022/2023 School Grade (ex: 3rd)

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

ENTER INFORMATION FOR CHILD #3

Registration Fee

Child 3 - First and Last Name

Child 3 - Gender Boy Girl

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

Child 3 - 2022/2023 School Grade (ex: 3rd)

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

ENTER INFORMATION FOR CHILD #4

Registration Fee

Child 4 - First and Last Name

Child 4 - Gender Boy Girl

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

Child 4 - 2022/2023 School Grade (ex: 3rd)

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

ENTER INFORMATION FOR CHILD #5

Registration Fee

Child 5 - First and Last Name

Child 5 - Gender Boy Girl

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

Child 5 - 2022/2023 School Grade (ex: 3rd)

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

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 2022/2023

Description

Please Fix the Following