REGISTRATION FORM
AWANA Clubs
Registration and Permission Form
MAIL TO:
AWANA @ Candlelight Christian Fellowship
5725 N. Poineer Drive
Coeur d'Alene ID 83815
(208)
772-7755
Cubbies _______ 4-5 preschool
Sparks ________ K – 2nd grade
T&T Girls _______ 3rd – 6 grade
T&T Boys _______ 3rd – 6 grade
24-7:
Trek ________ 7-8 grade
Journey ______ High School
Dear
Parents:
Please
fill out this registration and permission form and return it with the
registration fee to church. One per child.
Thursdays
night- Cubbies, Sparks, T&T Girls and Boys
Tuesday
night- 24-7: Trek (JV), Journey (HS)
Clubber’s
Name ____________________________________________________
Address:
_________________________________________________________
City_____________________________________________________________
Phone
#: _____________________________ Cell Phone #: ____________________
Birth
date: _____________ Age:_____________
Grade: _______________
Parent/Guardian
Name: ______________________________________________
Home
Church: ______________________________________________________
Have
you attended AWANA previously? ________ Church
___________________
*Health
problems, allergies, or any restrictions in game participation:
____________________________________________________________
________________________________________________________________________________________________________________
*Emergency
contact person if parents cannot be reached:
Name:
____________________ Phone #
_______________________________
Emergency
contact relation to child: ________________________________
Physician’s
Name: __________________Phone #:_____________________________
I
hereby give my permission for _____________ to attend and participate in the
Candlelight Christian Fellowship AWANA Club and any special activities and
events planned by the AWANA Club. I do hereby authorize emergency treatment be given if
necessary only after a reasonable effort has been made to reach me, the parent
(s) or guardian. I , the
undersigned, also agree to release and hold harmless the AWANA leadership,
Candlelight Christian Fellowship and AWANA Clubs International from any and all
liabilities or claims for personal injury which may be incurred by my child
while attending and participating in the AWANA Club and its activities and
special events.
Parent
or Guardian: _____________________________ Date __________________
Payment _____________________________________Date___________________