AWANA Signup
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a member of Lebanon Baptist Church?
*
Please Select
Yes
No
How many children are you registering?
*
Please Select
1
2
3
4
5
6
7
8
Registration Costs
Dues - $30 (Dues are waived for LBC members) | Handbook - $12 (Fee waived for members) | Uniforms - $12 | Bags - $7
Special Note
Puggles and Cubbies Club (2yrs-4yrs) are available for LBC Members and non-members who are participating in our Wednesday night activities (Bible Study, Prayer Meetings, etc). You may not drop off a 2yr-4yr old and leave our campus.
Child #1 Full Name
*
First Name
Last Name
Child #1 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #1 Birthday
*
MM/DD/YYYY
Child #1 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #1 Have Allergies?
*
Please Select
Yes
No
Please List Child #1's Allergies:
*
Child #1 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #1 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
Register A 2nd Child?
*
Please Select
Yes
No
Child #2 Full Name
*
First Name
Last Name
Child #2 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #2 Birthday
*
MM/DD/YYYY
Child #2 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #2 Have Allergies?
*
Please Select
Yes
No
Please List Child #2's Allergies:
*
Child #2 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #2 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
Register A 3rd Child?
*
Please Select
Yes
No
Child #3 Full Name
*
First Name
Last Name
Child #3 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #3 Birthday
*
MM/DD/YYYY
Child #3 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #3 Have Allergies?
*
Please Select
Yes
No
Please List Child #3's Allergies:
*
Child #3 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #3 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
Register A 4th Child?
*
Please Select
Yes
No
Child #4 Full Name
*
First Name
Last Name
Child #4 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #4 Birthday
*
MM/DD/YYYY
Child #4 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #4 Have Allergies?
*
Please Select
Yes
No
Please List Child #4's Allergies:
*
Child #4 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #4 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
Register A 5th Child?
*
Please Select
Yes
No
Child #5 Full Name
*
First Name
Last Name
Child #5 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #5 Birthday
*
MM/DD/YYYY
Child #5 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #5 Have Allergies?
*
Please Select
Yes
No
Please List Child #5's Allergies:
*
Child #5 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #5 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
Register A 6th Child?
*
Please Select
Yes
No
Child #6 Full Name
*
First Name
Last Name
Child #6 Age
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
13
Child #6 Birthday
*
MM/DD/YYYY
Child #6 Grade Entering
*
Please Select
2yrs
3yrs
K4
K5
1st
2nd
3rd
4th
5th
6th
Does Child #6 Have Allergies?
*
Please Select
Yes
No
Please List Child #6's Allergies:
*
Child #6 Needs The Following: (Select All That Apply) - Member
Handbook (Free)
Uniform ($12)
Bag ($7)
Child #6 Needs The Following: (Select All That Apply) - Non-Member
Handbook ($12)
Uniform ($12)
Bag ($7)
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2023-2024 Medical Consent Release
MEDICAL RELEASE: I understand that, where reasonably feasible, Lebanon Baptist Church will attempt to contact the emergency contact listed above prior to providing emergency medical treatment. In the event that the emergency contact cannot be or is not reached in an emergency, I give permission to Lebanon Baptist Church to make the decisions necessary for medical treatment. I understand and acknowledge that my child assumes all risks, including any risk associated with any special medical needs or conditions of my child that may arise out of participating in any activity at or with the Lebanon Baptist Church. I hereby release and forever discharge and hold harmless Lebanon Baptist Church and their former, current, and future officers, directors, employees, volunteers, agents, attorneys, insurers, and trustees from any and all liability, claims, demands, and losses of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from my child’s participation in any activity with Lebanon Baptist Church. I understand and acknowledge that this Release discharges Lebanon Baptist Church from any liability, claim, or demand that I may have against Lebanon Baptist Church with respect to any bodily injury, personal injury, illness, death, or property damage that may result from my child’s participation in any activity, whether caused by the negligence of Lebanon Baptist Church or its officers, directors, employees, volunteers, or agents or otherwise. I also acknowledge and agree that, except as otherwise agreed by Lebanon Baptist Church in writing, Lebanon Baptist Church shall not assume any responsibility for or obligation to provide financial assistance or other assistance, including, but not limited to, medical, health, or disability insurance in the event of injury or illness.
I have read and give consent to the medical release:
*
Yes
Signature
*
Amount Owed
I would like to pay by:
*
Please Select
Credit Card (Online/Immediate)
Check (In Person On Aug 17th)
PAY AWANA DUES BY CREDIT CARD (Powered by Square)
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Awana Dues
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