Bethel Memorial Baptist Church - Awana Club Registration Form

Awana Club Registration Form

Parent / Guardian			Contact Person
Name(s):		Home Phone:
Address:		Work Phone:
City:		Cell Phone:
State:	Zip Code:	E-Mail:
Family Church:		Other:
	Persons (other than parents) authorized to pick up the children:	Emergency:

Child's Name (First, Last)	Nickname	Birth Date	Gender	Grade	School	Need Book	Need Uniform
			M F
			M F
			M F
			M F
			M F

Clubber	Medical (food, allergies, meds, special needs)

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 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 Bethel Memorial Baptist Church 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 that 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3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only.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.

5) Any and all information provided to the Church shall be used for the purposes of Awana and will not be disseminated or distributed for any other purpose

I have read and agree to the Terms and Conditions stated above.

Thank You!