Awana Clubs Registration Form

CrossPointe Church Awana Clubs Registration

2024-2025 school year
Awana start date: September 15, 2024 - 6 pm to 7:30 pm

Club	Age Groups (Grade child will be in for the 2024-2025 School Year)	Registration Fee (per child/year)
Puggles	2yrs – 3.5yrs	$20.00
Cubbies	3.5yrs – 5yrs	$30.00
Sparks	Kindergarten – 2nd grade	$40.00
T&T	3rd grade – 5th grade	$40.00
Trek	6th grade – 8th grade	$40.00
Journey	9th grade – 12th grade	$40.00

Family maximum = $80.00 per year

How many children would you like to register (ages 2 - grade 12)?*
Quantity Registering for Puggles*
Amount for Puggles*
Quantity Registering for Cubbies*
Amount for Cubbies*
Quantity Registering for Sparks*
Amount for Sparks*
Quantity Registering for T&T*
Amount for T&T*
Quantity Registering for Trek*
Amount for Trek*
Quantity Registering for Journey*
Amount for Journey*
Total Registering*
Total Registration Fee*
Parent/Guardian's Information
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Phone*
Please enter a valid phone number.
Parent/Guardian's Email*
example@example.com
Second Parent/Guardian's Name

First NameLast Name
Second Parent/Guardian's Phone Number
Please enter a valid phone number.
Second Parent/Guardian's Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First Child
Child's Name

First NameLast Name
Gender

BoyGirl
Birthday

MonthDayYear
Date
Age
Grade
Grade child will be in for the 2024-2025 School Year
Club
Medical Information
Allergies
Type N/A if not applicable.
Medical Conditions
Type N/A if not applicable.
Medications currently being taken by this child:
Type N/A if not applicable.
List any special concerns you may have about this child or any information that would be helpful for their leader to know:
Terms and Conditions:
I understand that my child 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, CrossPointe Church and any
persons involved in the AWANA Club ministry.

In the event of an emergency that requires medical treatment for the above-named
child, I understand every effort will be made to contact me or the emergency
contact. If we cannot be reached, I am indicating below whether I give or do not give permission to the AWANA Club volunteers to secure the services of licensed
physician to provide the care necessary for my child’s well-being. I assume
responsibility for all costs connected to any accident or treatment of my child.

In an emergent situation requiring immediate medical attention, you child will be
taken the nearest hospital emergency room. My selection below indicates my
decision to give or not give my permission for a responsible person from
CrossPointe Church to have my child transported to that hospital and receive
treatment.
I have read and AGREE to the terms and conditions stated above.I DECLINE authorization for a responsible person from CrossPointe Church to seek medical attention for the above named child.

Second Child
Child's Name

First NameLast Name
Gender

BoyGirl
Birthday

MonthDayYear
Date
Age
Grade
Grade child will be in for the 2024-2025 School Year
Club
Medical Information
Allergies
Type N/A if not applicable.
Medical Conditions
Type N/A if not applicable.
Medications currently being taken by this child:
Type N/A if not applicable.
List any special concerns you may have about this child or any information that would be helpful for their leader to know:
Terms and Conditions:
I understand that my child 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, CrossPointe Church and any
persons involved in the AWANA Club ministry.

In the event of an emergency that requires medical treatment for the above-named
child, I understand every effort will be made to contact me or the emergency
contact. If we cannot be reached, I am indicating below whether I give or do not give permission to the AWANA Club volunteers to secure the services of licensed
physician to provide the care necessary for my child’s well-being. I assume
responsibility for all costs connected to any accident or treatment of my child.

In an emergent situation requiring immediate medical attention, you child will be
taken the nearest hospital emergency room. My selection below indicates my
decision to give or not give my permission for a responsible person from
CrossPointe Church to have my child transported to that hospital and receive
treatment.
I have read and AGREE to the terms and conditions stated above.I DECLINE authorization for a responsible person from CrossPointe Church to seek medical attention for the above named child.

Third Child
Child's Name

First NameLast Name
Gender

BoyGirl
Birthday

MonthDayYear
Date
Age
Grade
Grade child will be in for the 2024-2025 School Year
Club
Medical Information
Allergies
Type N/A if not applicable.
Medical Conditions
Type N/A if not applicable.
Medications currently being taken by this child:
Type N/A if not applicable.
List any special concerns you may have about this child or any information that would be helpful for their leader to know:
Terms and Conditions:
I understand that my child 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, CrossPointe Church and any
persons involved in the AWANA Club ministry.

In the event of an emergency that requires medical treatment for the above-named
child, I understand every effort will be made to contact me or the emergency
contact. If we cannot be reached, I am indicating below whether I give or do not give permission to the AWANA Club volunteers to secure the services of licensed
physician to provide the care necessary for my child’s well-being. I assume
responsibility for all costs connected to any accident or treatment of my child.

In an emergent situation requiring immediate medical attention, you child will be
taken the nearest hospital emergency room. My selection below indicates my
decision to give or not give my permission for a responsible person from
CrossPointe Church to have my child transported to that hospital and receive
treatment.
I have read and AGREE to the terms and conditions stated above.I DECLINE authorization for a responsible person from CrossPointe Church to seek medical attention for the above named child.

Fourth Child
Child's Name

First NameLast Name
Gender

BoyGirl
Birthday

MonthDayYear
Date
Age
Grade
Grade child will be in for the 2024-2025 School Year
Club
Medical Information
Allergies
Type N/A if not applicable.
Medical Conditions
Type N/A if not applicable.
Medications currently being taken by this child:
Type N/A if not applicable.
List any special concerns you may have about this child or any information that would be helpful for their leader to know:
Terms and Conditions:
I understand that my child 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, CrossPointe Church and any
persons involved in the AWANA Club ministry.

In the event of an emergency that requires medical treatment for the above-named
child, I understand every effort will be made to contact me or the emergency
contact. If we cannot be reached, I am indicating below whether I give or do not give permission to the AWANA Club volunteers to secure the services of licensed
physician to provide the care necessary for my child’s well-being. I assume
responsibility for all costs connected to any accident or treatment of my child.

In an emergent situation requiring immediate medical attention, you child will be
taken the nearest hospital emergency room. My selection below indicates my
decision to give or not give my permission for a responsible person from
CrossPointe Church to have my child transported to that hospital and receive
treatment.
I have read and AGREE to the terms and conditions stated above.I DECLINE authorization for a responsible person from CrossPointe Church to seek medical attention for the above named child.

Fifth Child
Child's Name

First NameLast Name
Gender

BoyGirl
Birthday

MonthDayYear
Date
Age
Grade
Grade child will be in for the 2024-2025 School Year
Club
Medical Information
Allergies
Type N/A if not applicable.
Medical Conditions
Type N/A if not applicable.
Medications currently being taken by this child:
Type N/A if not applicable.
List any special concerns you may have about this child or any information that would be helpful for their leader to know:
Terms and Conditions:
I understand that my child 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, CrossPointe Church and any
persons involved in the AWANA Club ministry.

In the event of an emergency that requires medical treatment for the above-named
child, I understand every effort will be made to contact me or the emergency
contact. If we cannot be reached, I am indicating below whether I give or do not give permission to the AWANA Club volunteers to secure the services of licensed
physician to provide the care necessary for my child’s well-being. I assume
responsibility for all costs connected to any accident or treatment of my child.

In an emergent situation requiring immediate medical attention, you child will be
taken the nearest hospital emergency room. My selection below indicates my
decision to give or not give my permission for a responsible person from
CrossPointe Church to have my child transported to that hospital and receive
treatment.
I have read and AGREE to the terms and conditions stated above.I DECLINE authorization for a responsible person from CrossPointe Church to seek medical attention for the above named child.

Emergency Contacts
Emergency Contact 1*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Emergency Contact 2*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.

Final Submission
Name of person who completed this registration form*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

CrossPointe Church Awana Clubs Registration

Awana start date: September 15, 2024 - 6 pm to 7:30 pm

Parent/Guardian's Information

Medical Information

Medical Information

Medical Information

Medical Information

Medical Information