Please Complete Both Sides of This Form and Sign

2017-2018 AWANA REGISTRATION

Please complete both sides of this form and sign.

Child’sLast Name ______Parent’s Last Name if Different:______

Father’s Name ______Mother’s Name ______

Address ______Phone ______

City ______Zip ______

Email Address(es) ______Cell Phone(Dad)______

Home Church ______Cell Phone(Mom)______

If your home church is HCBCAustin, in what ministry are you currently serving?______

 OVER 

Revised 08/10/2015

Name

/ Grade / Birth Date / Age / Sex / Club / Uniform Size / Uniform Fee / Book Fee / Registration
Fee / Other
Fees
Totals
Grand Total

 OVER 

Revised 08/10/2015

A limited number of scholarships are available. See Club Secretary.

AWANA is an entirely volunteer organization. The more volunteers we have, the more children we can serve for Him. We invite you to join the excitement and take the opportunity to impact children’s lives for eternity while serving God’s precious children in AWANA. Please see a Club Commander or email to join our AWANA team. God can use you tremendously to reach the next generation for His Kingdom!

______Please contact me, I would like more information about serving in AWANA.

***This section for office use only.***

Date / Check # / Item / Payment / Balance Due

AWANA 2017-2018

EMERGENCY CONTACT INFORMATION

Please list each child’s name, severe allergies or medical conditions, and who is authorized to pick up your child.Preschool children will only be released to an authorized individual who has the appropriate identification.

Name / List severe allergies or medical conditions of which we should be aware.

Emergency Contact Name (other than parent or guardian): ______

Phone: ______Cell Phone:______

Medical & Photo/Video Release for Minor

Medical Release: I (we) understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to a Hill Country Bible Church Awana Ministry representative to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child’s well-being.

Insurance Policy Company: ______Policy Number: ______

Photo/Video Release: I, as parent/guardian with legal responsibility for child(ren) listed on this form, hereby grant Hill Country Bible Church Austin the perpetual right to use photographs or video taken of my child/dependant for any legitimate purpose without compensation to my child/dependant, myself, my or my child/dependant’s heirs, executors, or assigns. Legitimate purposes may include, but are not limited to, advertising on the web, in newspapers, magazines, internal publications, displayed prints, worship services, special events, curriculum, etc.

______

Parent/Guardian SignatureDate

(Required)

 OVER 

Revised 08/10/2015