East Side Awana Club

East Side Awana Club

For kids in K-5th Grade - having fun, making friends, and learning about God!
Registration for 2025-2026 Awana Club
Name of person completing this form:*

First NameLast Name
Email
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Registration for East Side Awana Club

Here's the plan:
Program Details

Program Name: East Side Awana Club
Schedule: Thursdays, 6:30 PM – 8:00 PM
Location: 1100 Payne Ave, Saint Paul, MN 55130

This registration form includes:

1. Registration for up to 5 kids (info needed includes: grade, date of birth, address, and legal guardian/contact information as needed).

2. Pick-up Information

3. Emergency Information - safety is key!

4. Legal details - boring, yet must be done!

5. Signature

We're really looking forward to having you and your family with us this year!

Now for some pick up information:
Who is authorized to pick up the child(ren) listed in this registration?*
Are there any individuals that are not allowed to pick up the child(ren) listed in this registration?*

Yes, see belowNo
If yes, please list names of individuals and the names of the kids here.
I understand that my child must be picked up at 8:00 PM.

If my child has not been picked up and no contact can be made with myself or any of the listed caregivers by 8:30 PM, Grounding Waters will be required to contact Child Protective Services (CPS).
Got it!
Emergency Caregivers

In the event that I cannot be reached, the following individuals may be contacted and authorized to make decisions for my child/ren:
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Additional info to note:
relationship to child, etc.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Additional info to note:
relationship to child, etc.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Additional info to note:
relationship to child, etc.

Emergency Information

Safety is key!
1. Injuries During Play
I understand that while Grounding Waters staff and volunteers are intentional about safety, children may sustain minor or serious injuries (such as scrapes, bruises, or other injuries) while participating in activities and games.

If injury occurs, Grounding Waters staff/volunteers will notify me in a timely manner, provide immediate first aid care (e.g., bandaids, ice packs), and consult with me regarding further care if needed.

2. Medical Authorization
In the event of an emergency, I authorize Grounding Waters staff or volunteers to transport my child to a hospital or urgent care facility and to consent to emergency medical treatment if I cannot be reached.

3. Release of Liability
I release and hold harmless Grounding Waters, its staff, volunteers, affiliates, and representatives from any and all liability, claims, or expenses (including attorney’s fees) arising from injury, illness, or accident occurring during program participation, except in cases of gross negligence or intentional harm.

4. Emergency Contacts:
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
relationship to child
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
relationship to child
Preferred Hospital (if you have one)
Address (if known)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Care Physician
Phone Number

Area CodePhone Number
Is there any additional information that would be helpful for us to know:

A few legal details ...
1. Photo/Video Release (Optional)*

I give permissionI do not give permission
for my child’s photo or video to be taken during program activities and used for Grounding Waters communications (such as newsletters, social media, and promotional materials).
2. Behavior & Participation
Grounding Waters intentionally blends social emotional learning into each program evening. Our goal is to encourage kids to grow in their ability to participate in the Awana Club. There may be some times when Groundng Waters is not able to meet the needs of every child. I acknowledge that children are expected to behave respectfully toward peers, staff, and volunteers. Grounding Waters reserves the right to dismiss a child from the program for repeated disruptive or unsafe behavior.
Got it!
3. Indemnification Clause
I agree to indemnify and hold harmless Grounding Waters, its officers, directors, staff, and volunteers from and against any and all claims, damages, losses, and expenses—including legal fees—arising out of my child’s participation in this program.
Got it!
4. Jurisdiction & Venue
I agree that any legal action or proceeding arising from this agreement shall be brought exclusively in the courts of Ramsey County, MN and I consent to the personal jurisdiction of such courts.
Got it!
5. Arbitration/Mediation Clause
I agree that any dispute or claim arising from this agreement, my child’s participation in the program, or any related matters will first be submitted to mediation in good faith. If mediation is unsuccessful, the dispute shall then be resolved by binding arbitration under the rules of the American Arbitration Association (or a similar recognized body), and judgment upon the arbitration award may be entered in the courts specified above. I understand this means I am waiving the right to a jury trial.
Got it!

That's it - We just need to make it official!

please sign below
By signing below, I confirm that I am authoirized to register the child(ren) within this form. Where necessary I have included correct and full info for some or all children related to thier legal guardians. I have read, understood, and agree to the terms of this Participation Agreement. I agree to honor my typed signature below as equal to a printed and signed form.
Signature*
Type full name of the person completing this form
Should be Empty:

East Side Awana Club

Registration for 2025-2026 Awana Club

Registration for East Side Awana Club

First we're going to add the kids ...

Now for some pick up information:

Emergency Information

A few legal details ...

That's it - We just need to make it official!