Parent /Guardian *
Parent /Guardian
Primary Contact
Parent/Guardian DOB
Parent/Guardian DOB
Parent/Guardian Phone *
Parent/Guardian Phone
Parent/Guardian Address *
Parent/Guardian Address
Spouse
Spouse
Spouse DOB
Spouse DOB
Spouse Phone
Spouse Phone
Spouse Address
Spouse Address
Church Member? *
Check one
Persons (other than parents) authorized to pick up the children:
Persons (other than parents) authorized to pick up the children:
Phone of Person (other than parents) authorized to pick up the children:
Phone of Person (other than parents) authorized to pick up the children:
Child 1 *
Child 1
DOB Child 1
DOB Child 1
Child 2
Child 2
DOB Child 2
DOB Child 2
Child 3
Child 3
DOB Child 3
DOB Child 3
Child 4
Child 4
DOB Child 4
DOB Child 4
Insurance Information
Doctor Name Child 1
Doctor Name Child 1
Child 1
Doctor's Phone Child 1
Doctor's Phone Child 1
Insurance Company/Policy number
Doctor Name Child 2
Doctor Name Child 2
Child 2
Doctor's Phone Child 2
Doctor's Phone Child 2
Insurance Company/Policy number
Doctor Name Child 3
Doctor Name Child 3
Child 3
Doctor's Phone Child 3
Doctor's Phone Child 3
Insurance Company/Policy number
Doctor Name Child 4
Doctor Name Child 4
Child 4
Doctor's Phone Child 4
Doctor's Phone Child 4
Insurance Company/Policy number
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 participate in physical activities such as those held during Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Congregation Lion of Judah 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, 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 give permission for my child's photo/video to be used in variety of publications and news programs.Received Registration Fee of $15 is Non-Refundable if unable to attend the club.
Registration Fee:
Quantity:
Add To Cart
Book:
Quantity:
Add To Cart
T-Shirt:
Quantity:
Add To Cart
Bag:
Quantity:
Add To Cart