SCBC AWANA Registration Form

Clubber Registration

Southern Calvert Baptist Church | 12140 HG Truman Rd Lusby, MD 20657 | 410-326-6533 | www.scbcmd.com
AT THE END OF THIS FORM YOU WILL BE REQUESTED TO SUBMIT PAYMENT. PLEASE SELECT THE CORRECT QUANTITY OF CHILDREN YOU ARE REGISTERING AT THE CHECK OUT PHASE (e.g. if 3 children are registering, quantity must be equal to 3) IN ORDER TO ENSURE PRICE IS REFLECTED CORRECTLY. THANK YOU!
How many children are you registering?*
This SHOULD be equal to the QUANTITY in the payment section
PARENTS/GUARDIANS INFORMATION

PARENT/GUARDIAN 1
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
PARENT/GUARDIAN 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
PERSONS AUTHORIZED TO PICKUP CHILDREN

(NOT PARENTS/GUARDIANS)
Name*

First NameLast Name
Relationship*
Name

First NameLast Name
Relationship*
EMERGENCY CONTACT

(NOT PARENTS/GUARDIANS)
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Do you currently attend church?*

YesNo
If yes to the above, please tell us what church you currently attend*
Are you a member of Southern Calvert Baptist Church*

YesNo
Would you like to volunteer in AWANA?*

YesNo
ADULT VOLUNTEER INTEREST
Name

First NameLast Name
Interest in helping (Check all that apply)

WeeklyMonthlyEvery Other WeekSpecial Events
STUDENT LEADERSHIP VOLUNTEER INTEREST
Name

First NameLast Name
Interest Areas (check all that apply)

GroupGame TimeOther
INFORMATION ABOUT YOUR CHILD(REN)

Important note: To ensure our AWANA leaders are trained and prepared for the needs of every child, all information on this sheet is essential, including current updates to allergies and special needs information, regardless of prior year's recorded data and club participation.
CHILD 1
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
Gender*
School Name and Current Grade*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 2
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 3
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 4
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
Gender*
School Name and Current Grade*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 5
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 6
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 7
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 8
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 9
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
Register another child?*

YesNo
CHILD 10
Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
School Name and Current Grade*
Gender*
Needs Book (select if applicable)*

YesNo
Needs Uniform (select if applicable)*

YesNo
What size uniform?*

SmallMediumLargeExtra Large
Allergies (list all)*
Special Needs or Accommodations (describe)*
TERMS AND CONDITIONS

1. I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is risk of injury. I fully accept this risk and hold harmless from any legal liability, Southern Calvert Baptist Church and any persons involved in the Southern Calvert Baptist Church AWANA Club Ministry.

2. In the event of an emergency that requires medical treatkent for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child's well-being. I assume responsibilty for all costs connected to any incident or treatment of my child.

3. I grant permission for a photo of my child to appear in an unpublished club directory to be used by AWANA Leaders only. I also give permission for photo(s)/video(s) of my child to appear among other general club photos, videos, and social media as long as there is no identyfing information shown.

4. I understand the only individuals allowed to pick up the children listed on this form must be over the age of 18 and listed on the registration form.
Signature*

Clear
HEALTH/SAFETY

SCBC AWANA will be excercising current health guidelines and safety protocols to maintain a helathy environment for the AWANA students. AWANA leaders at SCBC will be trained in our latest procedures, emergency plans, child safety and security. Parents and guardians are the first line of defense when it comes to the overall health of the students. Pelase keep the children at home if they are not feeling well, have a fever, cold symptoms (runny nose, cough, nausea, etc.) or if an immediate family member is experiencing signs of illness.
Signature*

Clear
CLUBBER CONDUCT AGREEMENT

My clubber(s) agree to keep all cell phones or personal items stowed away. Items from home such as toys, stuffed animals, cell phones, ear pods and any other electric devices are not allowed during the entire AWANA evening.
Signature*

Clear
I have read and agree to all the terms listed above.

My signature and current date confirm my understanding and agreement to this document.
Signature*

Clear
How many children are you registering?
prevnext( X )
AWANA Registration Per Child + Service FeePlease select the QUANTITY of children you are registering (e.g. if 3 children are registering, quantity must be equal to 3)
$26.01 Quantity

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Clubber Registration

PARENTS/GUARDIANS INFORMATION

PERSONS AUTHORIZED TO PICKUP CHILDREN

EMERGENCY CONTACT

INFORMATION ABOUT YOUR CHILD(REN)