2023-2024 AWANA Child Registration

Parent/Guardian Information

Name

Address

Home Phone

Cell Phone

This address will receive a confirmation email

Do you have a church you regularly attend or are a member of?

Church Name:

Medical Information

Emergency Contact (other than parent)

Emergency Contact Phone

Personal Insurance

Yes No

Insurance Company Name & Policy #

Insurance Company Phone Number

Child(ren) Information

Cubbies MUST be 3 by September 1 and potty trained

Child 1

Name

Birthday

Grade

Pre-K Kindergarten 1 2 3 4 5 6

Cubbies MUST be 3 by September 1 and potty trained

Club

Cubbies (3-4 and potty trained) Sparks (K-2 grade) T&T (3-6 grade)

Allergies

NONE Peanuts Tree Nuts Gluten Dairy Dyes Eggs Other (specify below)

Other

Child 2

Name

Birthday

Grade Pre-K Kindergarten 1 2 3 4 5 6

Cubbies MUST be 3 by September 1 and potty trained

Club Cubbies (3-4 and potty trained) Sparks (K-2 grade) T&T (3-6 grade)

Allergies NONE Peanuts Tree Nuts Gluten Dairy Dyes Eggs Other (specify below)

Other

Child 3

Name

Birthday

Grade Pre-K Kindergarten 1 2 3 4 5 6

Cubbies MUST be 3 by September 1 and potty trained

Club Cubbies (3-4 and potty trained) Sparks (K-2 grade) T&T (3-6 grade)

Allergies NONE Peanuts Tree Nuts Gluten Dairy Dyes Eggs Other (specify below)

Other

Child 4

Name

Birthday

Grade Pre-K Kindergarten 1 2 3 4 5 6

Cubbies MUST be 3 by September 1 and potty trained

Club Cubbies (3-4 and potty trained) Sparks (K-2 grade) T&T (3-6 grade)

Allergies NONE Peanuts Tree Nuts Gluten Dairy Dyes Eggs Other (specify below)

Other

Participant Agreement

I/We, the parents/guardians of the named Activity Participant{s}, hereby give my/our approval to participate in any and all activities, including transportation to and from the activities. I/We know that participation in and transportation to/from these activities may result in serious injuries, disabilities or death and do hereby waive, release, absolve, indemnify, and agree to hold harmless the Activity Sponsor, sponsor’s coordinator, organizers, supervisors, participants, and volunteers from any claim arising out of any injury to my/our child{ren} whether the result of negligence or for any other cause. Further, the Participant {or parent/guardian if Participant is a minor} gives permission for photos or video that may be taken of them during this public activity may be used in a lawful manner by Calvary Baptist Church for promotional reasons. Though intended to be honored wherever presented, this document shall be governed by the law of the state of Michigan.

2023-2024 AWANA Child Registration

Description

Please Fix the Following