AWANA 2020-2021 Registration

Valley Fourth AWANA Registration

Starts SUNDAY September 13th from 10:30-11:30am at Valley Fourth
Please note:

Registration is required to participate. Seperate registration forms must be filled out for each child participating in AWANA.
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Grade Entering *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *

Area Code Phone Number
Home Number

Area Code Phone Number
E-mail *
Church
If you have a church home, please let us know.
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship
Phone Number *

Area Code Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Please list all persons authorized to pick up your child and their relationship to the child.
COVID Guidelines and Safety

Valley Fourth Church is committed to reducing the risk of COVID by following current COVID safety guidlines. These include self screening, limited capacity for rooms, social distancing, wearing masks for children Kindergarten and older, wearing masks by adult leaders, and sanitation protocalls for disinfecting facilities and hand washing. Additionally, children or volunteers experiencing any symptoms associated with COVID are not able to participate.
Agreement: *

I have read and acknowledge the COVID Guidelines
Informed Consent and Acknowledgement

Valley Fourth Church AWANA program September 2010-May 2021

In consideration of Valley Fourth Church, I for myself, or for the minor child named above, forever waive, release, and discharge Valley Fourth Church from any and all injuries, claims, disputes, liabilities, or actions resulting from Valley Fourth Church providing services for me and for my benefit regardless of location for the dates identified above, except for injury or damage arising out of Valley Fourth Church's negligence or willful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks.
Medical Release and Authorization

I give permission for my child to participate in the AWANA program at Valley Fourth Church. My child has my permission to participate in all activities except as noted by me. Should my child need emergency medical treatment and I cannot be reached, I hereby give permission for Valley Fourth Church to authorize any necessary treatment.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *

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Valley Fourth AWANA Registration