Awana Registration/Medical Release

CommunityBibleChurch - Crofton, NE

Club Cubbies Sparks T and T

(3 and 4 yrs) (K – 2nd) (3rd – 6th)

*must be potty trained

Transfer from ______Awana Club. Please provide proof of completed book.

Church name

Child’s Name ______

Gender: M F date of birth ______Age ______Grade ______

School ______

Parent/Guardian Name ______

Home address ______

Home phone number ______

Cell phone (or other number where you may be reached during Awana)

______

Email (for Awana updates and newsletters)______

Often times the Awana leaders like to share information with parents of their clubbers, may we share your contact information with your child’s Awana leader? Yes/no

Person responsible for transportation to/from club ______

The following people, in addition to parents, have my permission to pick up my child from Awana (if only parents are allowed to pick up child, then write none)

______

Please circle one:

I am interested in volunteering in Awana.

I am interested in information about CommunityBible Church.

I would like to visit with Pastor Mark.

If you have any questions feel free to contact the Awana commander, Heidi Clark at 402-373-4948 or Pastor Mark at 402-388-2305.

Medical Information

Is your child allergic to any medications

Foods

Insects

Environmental

If yes, explain ______

Does your child have any special needs? ______

Please explain ______

______

Any other medical concerns ______

I give consent for a responsible adult at the AWANA ministry at CommunityBibleChurch to administer appropriate first aid to my child when needed. I also give consent to secure additional emergency treatment for my child, under the following conditions: reasonable effort has been made to find me at the Church or at home: the consensus of several adults is that care is needed prior to the probable return of the parent/guardian to pick up the child. I understand it is my responsibility to notify the classroom leaders as to where I can be reached in the event of an emergency.

Signature ______

Date ______

In case of emergency and a parent cannot be reached, please contact:

______

Namephone number

______

Namephone number

______

Namephone number

CommunityBibleChurch may take photos and videos from time to time during the club year. These will be used for publicity purposes and club activities only. Your signature below grants permission for CommunityBibleChurch to use videos and photos of your child for publicity purposes. Periodically pictures are submitted to the newspaper.

______

Parent signaturedate

Fees and payments

Clubbers are asked to bring weekly dues of 25c. The dues collected will help to cover costs of club (awards, supplies, items for store etc). Clubbers will receive points each week they bring their dues. Points are turned into Awana bucks at the end of each week. These Awana bucks are used to “buy” things in the Awana store.

Clubbers are also responsible for purchasing their handbook and uniform. See the attached sheet for prices of these items. The Awana commander will place orders of handbooks and uniforms regularly.

Please make checks payable to CommunityBibleChurch. Scholarships and payment plans are available upon request. If you find the costs to be a financial burden for your family,please speak with the Awana Commander, Heidi Clark or Pastor Mark. We want Awana to be available to all children!

If you are combining payment for several children in one check, please list the other children here so we can be sure you are properly credited.

______

Awana use only

Club ______Uniform size ______

Handbook ______

Amt Paid ______Check # ______

There are 4 ways to turn in registration

1)Bring to Awana Registration and Family BBQ night

2)Email them to the Awana Commander, Heidi Clark at

3)Mail them to the church:

CommunityBibleChurch

ATTN: Awana

54669 Hwy 12

Crofton, NE 68730

4)Bring them to Awana on the first night of Awana Clubs