Awana

Awana Clubber Registration 2018-2019
KBC Awana Club

5204 Princess Anne Rd

Virginia Beach, VA 23462

PLEASE USE THIS FORM TO REGISTER NEW OR RETURNING AWANA CLUBBERS. RETURNING CLUBBERS, HOWEVER, WILL BE MAILED A RE-REGISTRATION FORM IN THE MAIL.
Parent/Guardian
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Cell Phone Number

- Area Code Phone Number
Work Phone Number

- Area Code Phone Number
Emergency Contact during club time (other than parents) *
Emergency Contact Number *

- Area Code Phone Number
E-mail
Persons (other than Parents) authorized to pick up children
Home Church:
Student Information
Child's Name *

First Name Last Name
Nickname
Birth Date *

- Month - Day Year
Gender *

Female Male
Grade *
Salvation/Baptism Dates
Needs Book Needs Uniform
Shirt Size
Please list any allergies, meds, or special needs your student may have

Additional Clubbers
Child's Name

First Name Last Name
Nickname
Birth Date

- Month - Day Year
Gender

Female Male
Grade
Salvation/Baptism Dates
Needs Book Needs Uniform
Shirt Size
Please list any allergies, meds, or special needs your student may have

Additional Clubbers
Child's Name

First Name Last Name
Nickname
Birth Date

- Month - Day Year
Gender

Female Male
Grade
Salvation/Baptism Dates
Needs Book Needs Uniform
Shirt Size
Please list any allergies, meds, or special needs your student may have

Additional Clubbers
Child's Name

First Name Last Name
Nickname
Birth Date

- Month - Day Year
Gender

Female Male
Grade
Salvation/Baptism Dates
Needs Book Needs Uniform
Shirt Size
Please list any allergies, meds, or special needs your student may have

Additional Clubbers
Child's Name

First Name Last Name
Nickname
Birth Date

- Month - Day Year
Gender

Female Male
Grade
Salvation/Baptism Dates
Needs Book Needs Uniform
Shirt Size
Please list any allergies, meds, or special needs your student may have

Volunteer information (optional)
I am interested in helping:

Weekly Every Other Week Monthly For Special Events
Note: All Awana Club leaders and listeners must submit to a background check before working with the children.
Terms and Conditions
1) I understand that my child/children may partcipate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability Kempsville Baptist Church and any persons involved in the Awana Club Ministry.

2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the Awana volunteers to secure the services of a 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.

3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information shown.

4) I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand.

By writing my full legal name in the box below and clicking "SUBMIT" I acknowledge that I have read and agree to the Terms and Conditions stated above.
Full Legal Name *
Should be Empty: