Registration Form

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2018-19 AWANA REGISTRATION

Grace Community Church Meeting at: 424 N. Lovers Lane Mailing: 2525 S. Lovers Lane Visalia, CA 93292 Parent/Guardian

1st night is Wednesday, September 5th! 6:00 pm -PLEASE PRINT-

Contact #

Contact Person

Name(s): ______________________________

Cell Phone:

_____________________

___________________

Address: ______________________________

Home Phone: _____________________

___________________

City:

Other Contact* _____________________

___________________

________________ Zip: __________

Persons (other than parents) authorized to pick-up children *Emergency Contact during Club Time (other than parents) __________________________________ Relationship:_______________________________ Puggles - $20 (On-site Leader’s children only) Cubbies - $25 (3 & 4 yr. old) Sparks - $25 (K’s-2nd gr) TNT - $30 (3rd-6th gr)

Last Name

First Name

Birthdate

M/F

Grade

CLUB

________________________ _______________________ ___-___-___

M/F

______

____________

________________________ _______________________ ___-___-___

M/F

______

____________

________________________ _______________________ ___-___-___

M/F

______

____________

________________________ _______________________ ___-___-___

M/F

______

____________

Name:_____________________________ Allergies/Medical condition ______________________________________________ Name:_____________________________ Allergies/Medical condition ______________________________________________

$5 discount per child for leaders Are you a leader? Yes __ No __ I would like to be a leader Yes __ No __ What age group would you like to work with? ________________ Note: All Awana Club leaders must submit to a background check before working with children. Terms & 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 Grace Community Church 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, I 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 grant permission for GCC to post photos that include my children on the GCC website. I understand that, at any time, I can rescind my permission by submitting a written request to Grace Community Church I DO NOT give my permission to GCC to post photos of my children. I have read & agree to the Terms & Conditions stated above X ___________________________________________________ Signature

_____________________ Date

Has your child previously attended AWANA at GCC?

 YES

 NO

Another Church?  YES

 NO

If YES, current book or last book completed: _______________________________________

FOR OFFICE USE ONLY: Registration Book # ____ T-Shirt Vest TOTAL

$ ________ $ ________ $ ________ $ ________

 CASH

$ ________

 CHECK # __________

_______________ Entered into Shelby database