2022-2023 Awana Registration and Family Information Sheet

Awana is a Bible based club for children that includes Bible memory and teaching, and games.

We do not charge fees, but we do ask parents to purchase handbooks for $11 and Cubbie or Sparks vests ($11) or T&T shirts ($16). A tax deductible donation can be given at any time if you want to support this ministry.

If you have any questions, please contact the church office @ 503.630.5325 or info@estacadafbc.org

Please give the CHILD'S information unless otherwise noted.

Home Church

Name

A. Current Grade

Pre Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Birthdate

Gender

Address

Mailing Address (If different)

Please select which meeting your child will be attending:

Wednesdays @ 6:30 pm Online

Parent / Guardian / Family Information PLEASE LIST FULL NAME

A. You Are:

Mother Father Guardian Other

A. Name

A. Best Phone# to reach you DURING Awana Club.

A. Email

This address will receive a confirmation email

A. Secondary Adult

Mother Father Guardian Other

Secondary Adult Name

Secondary Adult Best Phone number to reach you during Awana Club.

Is this child brought to Awana Club regularly by someone else that is not their parent or guardian?

Yes No

Name and relationship to child

Phone

PERMISSIONS

A. I give permission for my child to attend ALL EFBC Awana Club MEETINGS and organized OUTINGS during the club year. Unless I revoke permission for the specific outing in writing.

Yes No

A. Awana Games are fun and a part of Awana club Game Time. Including vigorous play outdoors and in our gym. I giver permission for my child to participate in these Awana activities.

Yes No Yes, with restrictions

A. PHOTO/VIDEO/MEDIA RELEASE: EFBC's Awana Club Photographer and staff take photos and videos during the Awana year of Awana activities. These photos may be used to help promote Awana Club.

I give permission for EFBC Awana Club to use photos or videos of my child for the described purposes listed. I DO NOT give permission for EFBC Awana Club to use photos or videos of my child for the described purposes listed. I give permission with the following restrictions:

Medical Information:

A. Allergies, Special Needs, & Medical Conditions. Please list any instructions for this child that would be helpful to our staff in this area of the form. (i.e. allergies/ADHD / physical limitations / Custody info. / Medications, etc...) PLEASE MARK N/A IF NONE EXIST.

A. Insurance Company Name:

A. In the event a parent or guardian cannot be reached in an emergency situation, please contact the following: Name - Relationship of Child - and Contact Phone #

I give my consent for medical treatment.

Yes No

BY SUBMITTING YOUR CHILD'S REGISTRATION YOU ARE AGREEING WITH THE PARTICIPATION AGREEMENT BELOW . Participation Agreement I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Yes, I have read and accept No

Awana Payment, use drop down to choose payment amount.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2022-2023 Awana Registration and Family Information Sheet

Description

Please Fix the Following