Parent/Guardian Name *
Parent/Guardian Name
Home Address
Home Address
Phone *
Phone
(best phone number to reach you by)
(If applicable)
Authorized to pick up child(ren) *
Authorized to pick up child(ren)
child 1 name
child 1 name
(mm/dd/yyyy)
Gender
Please enter the name of you child's school and the grade they are in.
child 2 name
child 2 name
(mm/dd/yyyy)
child 2 gender
Please enter your child's school name and grade
child 3 name
child 3 name
(mm/dd/yyyy)
child 3 gender
Please enter your child's school name and grade
child 4 name
child 4 name
(mm/dd/yyyy)
child 4 gender
Please enter your child's school name and grade
child 5 name
child 5 name
(mm/dd/yyyy)
child 5 gender
Please enter your child's school name and grade
(Be sure to include which child the issues applies to)
If you have more than 5 children, please complete this form, and submit another form to register the other children
Emergency Contact Name *
Emergency Contact Name
Please indicate the relationship the emergency contact has to child(ren)
Emergency Contact Phone
Emergency Contact Phone
Releases
MEDICAL: As a parent/legal guardian of the children registered for Awana on this form, I authorize the administration of emergency medical treatment for them during this year-long program. I understand that all reasonable safety precautions will be taken at all times by Christ’s Church and/or its agents. I also understand that in the event of a medical emergency, every attempt will be made to contact me, and/or any other emergency contact people listed below immediately. I will not hold Christ’s Church or its agents liable for any accident, injury, or disease incurred to/by my child(ren) while they are attending this school year-long program. This consent will be in effect for the duration of Christ’s Church 2016-2017 Awana program. *
required to check one:
PHOTO: Christ’s Church has a website that features our Awana club. We would like to put Awana photos on it so others can see what a great time we have here. From time to time we may send out a newsletter which may include Awana photos. Also, at the end of the year, we recap the whole Awana year in a slide show at the Closing Ceremony. There may be other times we will be using Awana photos – in order to do that, we’d like your permission to possibly feature your child. As a parent/legal guardian of the children registered for Awana on this form, I give permission to Christ’s Church to use photographs or video taken of my child(ren), during the 2016-2017 Awana year for use in Awana and Christ’s Church publications such as brochures, newsletters, display boards and other print publication, as well as electronic versions of the publications and the Christ’s Church and Awana web site for the purpose of promoting the Awana ministry and activities at Christ’s Church. *
(please select-required)
SOCIAL: We encourage Godly communication between leaders and clubbers. The content must be limited to club information, encouraging the clubber to progress in their Awana handbook, and encouraging their spiritual development. No communication between leader and clubber is acceptable without prior parental/legal guardian consent. Permitted communication is limited to public forums on social network sites, and phone calls where the parent is informed as to the content of the call. No direct private messages are allowed. I give permission to Awana leaders from Christ’s Church to have contact with my child(ren) on the phone and/or through public forms of social networking sites. *
required
Electronic Signature *
Electronic Signature
Please include first and last name as verification you completed this form - your electronic signature