Awana Registration 2022-2023

CLUBBER INFORMATION

A separate form must be filled out for each child
Clubber Name*
Gender*
Address*

Address

Street Address Line 2

CityState / Province

Zip
Birth Date*

MonthDayYear
Date
Church Attending
Age*
Grade in school*
Does child have an IEP?*
This information will be helpful to us when we are working on memory verses.
Siblings (names, ages)
TRANSPORTATION & AUTHORIZATION
Transportation TO club will be*
Due to seating limitations, if choosing "Ride Church Van" option, your request will be reviewed by the Club Director.
Transportation FROM club will be*
Please read our policies in the Parent Guide regarding Pick-Up procedures.
Below you must list all individuals who will be authorized to Pick-Up your child from club.

Please note: IF THEIR NAME IS NOT ON THIS LIST, THEY WILL NOT BE ABLE TO PICK UP YOUR CHILD.
The following individual is authorized to pick-up clubber: Name Relationship to Clubber Phone Number
The following individual is authorized to pick-up clubber: Name Relationship to Clubber Phone Number
The following individual is authorized to pick-up clubber: Name Relationship to Clubber Phone Number
The following individual is authorized to pick-up clubber: Name Relationship to Clubber Phone Number
PARENT / GUARDIAN INFORMATION
Mother Name (or Guardian #1)
Home Phone
Cell Phone
Would you like to receive TEXT MESSAGE notifications on this mobile number for club updates such as cancellations, events & reminders?
If "Yes" you will receive instructions on how to join our messaging service. Please only choose this option for one parent or guardian.
Father Name (or Guardian #2)
Home Phone
Cell Phone
Would you like to receive TEXT MESSAGE notifications on this mobile number for club updates such as cancellations, events & reminders?
If "Yes" you will receive instructions on how to join our messaging service. Please only choose this option for one parent or guardian.
MEDICAL INFORMATION
Medical conditions and/or Allergies
RELEASE & CONSENT
PLEASE READ AND INITIAL EACH OF THE FOLLOWING:
I agree that I hereby hold harmless and waive any and all claims against First Baptist Church, its staff and leaders for any accident, bodily or personal injury, damage to or loss or theft of any property, illness or death of any person.*
Initial
I give permission for my child's photo to be taken during Awana Club and used in any church publication, including the church's videos, websites, social media, publicity, promotional materials, or display purposes. I hereby release the church, its staff and leaders from all claims and liability relating to said photographs. IF YOU DO NOT WANT YOUR CHILD'S PHOTO PUBLISHED YOU MUST MARK "NO" IN PLACE OF INITIALS.*
Initial
In the event my child becomes ill or injured, I authorize the staff of Awana or First Baptist Church to authorize medical treatment as necessary to insure the well-being of my child.*
Initial
I understand tat ONLY an authorized parent or individual (who are listed on this form) can pick up my child and MUST COME INSIDE THE BUILDING to do so. I also understand that if I designate on this form that my child has permission to walk, ride bike, or drive themselves that once my child checks out of club and leaves the building that First Baptist Church, its staff and leaders are no longer responsible for the safety of my child.*
Initial
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

CLUBBER INFORMATION

TRANSPORTATION & AUTHORIZATION

PARENT / GUARDIAN INFORMATION

MEDICAL INFORMATION

RELEASE & CONSENT