Awana Registration

Please note: club dues of $20/year are payable on first night of club attendance.
First Name*
Middle Name*
Last Name*
Birth Date*
Gender*	Male Female
Address*
City*
State*
ZIP*
Home Phone*
School*
Grade*
Family Church*
Child has previously participated in an Awana Club*	yes no
Child needs a handbook*	yes no
Child needs a uniform*	yes no
T-shirt size*

Mother's Name
Custodial Parent*	yes no
Phone:
Home
Cell
Email
I am interested in helping in Awana (Note: All Awana Club leaders and listeners must submit to a background check before working with children)	yes no

Father's Name
Custodial Parent*	yes no
Phone:
Home
Cell
Email
I am interested in helping in Awana (Note: All Awana Club leaders and listeners must submit to a background check before working with children)	yes no

Emergency Contact (during club time)*
Phone:
Home*
Cell*

Persons (other than parent) authorized to pick up child
Doctor Name*
Doctor Phone*
Dentist Name*
Dentist Phone*


Medical, Allergy or Special Information
Please list all allergies, medications and/or special needs your child may have.

Terms & Conditions I understand that my child may participate 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, Village Baptist Church and any persons involved in the Awana Club ministry. In the event of an emergency the 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 permmision 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. I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only.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. 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 typing in your name here you agree that you have read and understand all of the terms and conditions*
I accept all terms and conditions*	Accept