Parent /Guardian #1 *

Primary Contact

First Name

Last Name

Parent /Guardian #1 Phone *

(###)

###

####

Parent /Guardian #2

First Name

Last Name

Parent /Guardian #2 Phone

(###)

###

####

Postal address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church Member? *

Check one

Yes

No

Persons (other than parents) authorized to pick up the children:

First Name

Last Name

Phone of Person (other than parents) authorized to pick up the children:

(###)

###

####

Child 1 *

First Name

Last Name

DOB Child 1 *

MM

DD

YYYY

Child 2

First Name

Last Name

DOB Child 2

MM

DD

YYYY

Child 3

First Name

Last Name

DOB Child 3

MM

DD

YYYY

Child 4

First Name

Last Name

DOB Child 4

MM

DD

YYYY

I am interested in helping

Note: All Awana Club volunteers must submit to a background check before working with the children

Puggles Team

Cubbies Team

Sparks 1 Team

Sparks 2 Team

T & T Team

Secretary Team

Security Team

Worship Team

Sale Team

Substitute Team

Child Care Team

Special Occasions

Special Needs Child

All of the above

Terms and Conditions *

1) I understand that my child/children may participate in physical activities such as those held during club 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 wellbeing. 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 a variety of publications and news programs. 4) Registration Fee of $15 per Child is Non-Refundable if they are unable to attend the club.

I have read, understood and accepted the information above. I understand that the Awana Administration will verify the information that I provide and send me an email with an invoice to pay the registration in order to confirm my child's/children's registration.