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:

Child's Name
(Last, First)
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3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only.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!

Bethel Memorial Baptist Church
715 Chestnut Lane
Easton, PA 18045
Phone: 610-253-2565 / Fax: 610-253-5490

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