Awana Registration Form 2022-2023

Join the fun! Awana Starts Wednesday, August 24th, 2022!

Join us at Awana! Awana is a kids club where we will learn about Jesus, hang out with friends, and have fun! We meet on Wednesdays 6-7:30pm throughout the school year from August to the end of April. It is for children 3 years old to 5th grade. Hope to see you there!

Parent/Guardian Information

Name

This address will receive a confirmation email

Phone

Address

Relationship to the child(ren).

Child #1 Information

Name

Birthdate

Grade

Medical or other information we need to know. (Please include any food allergies.)

Child #2 Information

Name

Birthdate

Grade

Medical or other information we need to know. (Please include any food allergies.)

Child #3 Information

Name

Birthdate

Grade

Medical or other information we should know. (Please include any food allergies.)

Child #4 Information

Name

Birthdate

Grade

Medical or other information we should know. (Please include any food allergies.)

Emergency Information

Emergency Contacts (Other than listed above.) Names & Phone numbers

Physician Name:

Physician Phone Number:

Emergency Authorization

I hereby authorize First United Presbyterian church leaders/staff to act on my behalf when I cannot be contacted, IN CASE OF AN EMERGENCY, resulting in the need of medical attention for my son’s/daughter’s named above. I also agree to not hold First United Presbyterian Church, Moline, IL liable for any incident that may result from participation in any of our activities or events, as a result, of my child's participation in its activities. Furthermore, I agree to reimburse First United Presbyterian Church, Moline, IL for any medical expenses.

Electronic Signature*

*By entering my name above, I am providing my digital signature for Emergency Authorization on this form.

Other Information

Dismissal Information: Who may pick up your child(ren) at the end of Awana each week?

Does your family attend church? If so, where?

If your child(ren) are visiting our church, who are they a guest of?

Permission of Photography

May we have permission to photograph your child(ren)?

Yes No

May we have permission to use your child(ren)'s photograph for the purposes of promotion?

Yes No

I further understand that if I do not wish for my child(ren) to be photographed, it is my responsibility to notify the ministry director.

Electronic Signature*

*By entering my name above, I am providing my digital signature for Permission of Photography on this form.

Awana Registration Form 2022-2023

Description

Please Fix the Following