Avondale Adventures Registration Spring 2025

Avondale Adventures

Registration

February 19 - April 9, 2025
Avondale Presbyterian Church

2821 Park Rd

Charlotte, NC 28209

Cost: $75 per child or $150 per family, includes a catered dinner each night.

Registration: Registration is complete when forms and payment are received. Registration closes February 12, 2025.

Questions:

SPECIAL DATES

Avondale Adventures Leads Worship
Sunday, April 13th, at 10am
REGISTRATION FORM

register each child separately
Child's First Name:*
Child's Last Name:*
Child's nickname/goes by:
Date of Birth*

MonthDayYear
Current School:*
Current Grade:*
Please note: Your child must be currently attending K-5th grade to attend this program.
Child's Home Address:*
full address
Best Phone # for Family:*

Parents / Guardians

contact info
First & Last Name #1*
Parent/Guardian #1
Email address #1*
example@example.com
Mobile Phone #1*
Parent/Guardian #1
Other Phone #1
Parent/Guardian #1
First & Last Name #2
Parent/Guardian #2
Email address #2
example@example.com
Mobile Phone #2
Parent/Guardian #2
Other Phone #2
Parent/Guardian #2
Please share any information that might be helpful for our volunteers to ensure that your child has a positive experience.*
if you can't think of anything, type NA
Food: We serve dinner at Avondale Adventures. Please be sure to list food allergies on the Medical form.

Cancellation: If you need to cancel your child’s registration, please notify the church office as soon as possible by calling: 704-333-6194.

Next pages: Emergency Medical Form and Photo Release Form

PERMISSION FOR MEDICAL TREATMENT:

This is to certify that as the parent / guardian of: ____(field below-Full Name of Child)_____/____(field below-Date of Birth)_______ who is ____(field below)___ years of age, that if an emergency should arise while my child is participating in Avondale Adventures, and I am unable to be notified, I give my permission to the medical staff selected by the Avondale Adventures Director(s) or Avondale staff to administer or authorize any medications or treatments, including anesthesia or surgery, that are deemed necessary.

Signature / Date ___(fields below)____
Full Name of Child*
medical form
Child's Date of Birth*

MonthDayYear
Date
who is _____ years old*
age
Parent / Guardian Signature*

Clear
Date you sign Emergency Medical Form*

MonthDayYear
today
Contacts for the Emergency Medical Form

(Emergency contacts may be different than Parent/Guardian contacts on the Registration Form)
Emergency Contact #1 Name*
Parent/ Guardian
Emergency Contact #1 Mobile*
phone
Emergency Contact #1 Work/Other
phone
Emergency Contact #1 Email
email
Emergency Contact #2 Name*
Emergency Contact #2 Mobile*
phone
Emergency Contact #2 Work/Other
phone
Emergency Contact #2 Email
example@example.com
Additional Contact Person in case of emergency
First & Last Name
Additional Contact Person - Relationship
relationship
Additional Contact Person - Mobile
phone
Additional Contact Person - Work/Other
phone
Medical Information:

Please upload a copy of the insurance card your child is covered by.
File Upload

Cancelof
Hospital Preference*
Location/ Address*
Hospital Preference
Does your child have allergies to food or drugs, any physical restrictions, etc. that we should be aware of?*
Type NA if none
Has your child received a tetanus shot in the past two years?*
Waiver Agreement

I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C. do hereby release and discharge Avondale Presbyterian Church, and its authorized volunteers and staff from liability for any injuries occurring out of my child’s use of the facility. Furthermore, in case of an accident or medical emergency, if the staff or volunteers are unable to contact the parent(s)/guardian(s) for participants, 17 and under, I hereby grant permission to said staff to administer necessary first aid and/or take registrant to the nearest hospital or medical facility for additional treatment. I understand that I as the parent or guardian am responsible for ambulatory, hospital and medical fees that are associated as a result of receiving the appropriate and necessary medical care. I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C. understand and am aware that the recreational activities conducted in and through the church facilities/property involve a risk of injury. I voluntarily allow my child to participate in these activities with the knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury. I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C., understand that I am responsible for any damage or breakage to Church property caused by my child as identified by the instructor, staff or church representative.
Parent/Guardian Signature Waiver Agreement*

Clear
Date*

MonthDayYear
Date

Photo Release Form
I hereby grant permission to Avondale Presbyterian Church to use photographs and/or video of me/my child taken at Avondale Presbyterian Church in publications, news releases, online, and in other communications related to the mission of Avondale Presbyterian Church. If you change your mind, please contact the Church Office.
Picture Release*

Yes, I allow pictures to be used. (Complete names below)No, sorry, not at this time.
Your Name And Your Children's Names*
Photo Release form
Parents/Guardians*
Photo Release form
Signature for Photo Release*

Clear
Date*

MonthDayYear
Date
Next pages: Volunteer Sign-Up

Avondale Adventures encourages parent participation! It is so important for our children to see us engaged and interested in their activities, and more importantly, active in their faith lives! In order to ensure a fun and safe environment for all of our children, we are asking each family to volunteer for at least two nights of Avondale Adventures. Please indicate dates you are available below (you must select at least two dates; however, if you are interested in volunteering for additional dates or are available on multiple dates, there is opportunity to indicate this below: *

MonthDayYear
Date
MonthDayYear
Date
Additional comments or dates:
I am interested in volunteering EVERY Wednesday! Hooray!

YES!No

Avondale Adventures Fall 2024 Registration
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Avondale Adventures - CHILDAvondale Adventures Registration
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Avondale Adventures - FAMILYAvondale Adventures Registration- 2 or more children. (Please note you must complete the form again for each additional child.)
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I have already paid but need to register an additional childAvondale Adventures Registration
$ Free Quantity



Total

$0.00
You are done with your Avondale Adventures registration forms!
(Look for an email from: Avondale Presbyterian Church via JotForm)

For more information about Avondale ministries, visit our website: www.avondalepresbychurch.org

Avondale is a 501(c)3 non-profit organization.

Contact/ Questions:

Cheryl Judd-Magee
cjuddmagee@gmail.com

Avondale Presbyterian Church
2821 Park Rd, Charlotte, NC 28209
www.avondalepresbychurch.org
Should be Empty:

REGISTRATION FORM

Parents / Guardians

Contacts for the Emergency Medical Form

Waiver Agreement

Photo Release Form