Valley View Christian Church- AWANA 25605 124th Ave SE, Kent, WA 98030
2017-2018 REGISTRATION FORM
(PLEASE PRINT LEGIBLY)
FAMILY INFORMATION
FAMILY LAST NAME:______HOME #:______
MAILING ADDRESS: ______CITY: ______ZIP:______
PARENT OR GUARDIAN:______CELL# ______
PARENT OR GUARDIAN: ______CELL#______
E-MAIL: ______
FAMILY CHURCH: ______NONE:______
CLUBBER INFORMATION
Name / Boy/Girl / DOB (MM/DD/YYYY) / Grade / ClubPHOTO RELEASE
During church events we take pictures of clubbers participating. Please indicate if Valley View Christian Church (VVCC) has permission to post these photos in the church for decoration or place a photo on the church website or on the church Facebook page. (please circle) YES NO
MEDICAL RELEASE
I give permission for my child(ren)______to participate in the AWANA program at VVCC. I understand that VVCC will take every precaution and care to ensure my child’s safety. All leaders will provide proper supervision and will exercise every precaution to avoid accidents, esp. during games. I hereby release VVCC, and all leaders from any liability and from any and all claims against them, individually or collectively, for any injuries which might be received during my child’s participation in the Awana programs at VVCC.
However, should there be an emergency situation: I give my written consent to all supervisors to make decisions concerning the medical treatment of my child(ren). In the event I cannot be reached in an emergency, I hereby give permission to the hospital, physician or dentist selected by the event leader to transport, order x-rays, routine test and treatments, hospitalize, secure proper treatment for and to order injection and/or anesthesia and/or surgery for the individuals as named above. I further agree to pay reasonable costs for the medical treatment rendered.
Please list any and all pertinent medical history information including allergies, special instructions, etc.; we need to be aware of pertaining to each of the children named above:
______PICK UP AND EMERGENCY CONTACTS
Emergency contact during Awana other than parents. This is used if parents cannot be reached at the above numbers.
Name: ______Phone: ______
Relationship to child(ren): ______
Signature of Parent or Guardian:______Date:______
* Club dues not to exceed $85.00 per family if you have multiple children attending. Club dues help cover the cost of patches/badges, Awana store, Grand Prix car kit, Grand Prix trophies and medals, end of year awards, and many other things.
Cubbies / Price / Qty / Subtotal*Yearly Club Dues-for awards and supply cost / $35.00
Handbook / $12.00
Cubbies Vest- L(size 6) or XL(size 8) / $12.00
Handbook Bag / $ 7.00
Total:
Sparks / Price / Qty / Subtotal*Yearly Club Dues- for awards and supply cost / $35.00
Handbook / $12.00
Sparks Vest- M(size 8), L(size 10), or XL(size 12) / $12.00
Handbook Bag / $ 7.00
Total:
T & T / Price / Qty / Subtotal*Yearly Club Dues- for awards and supply cost / $35.00
Handbook / $12.00
T & T Shirt- YS(size 10), YM(size 12), YL(size14), Adult S, and Adult M –the kids will be wearing these for about 2 years while they complete the 2 Discovery books. / $16.00
Handbook Drawstring Backpack / $ 7.00
New- Handbook Sling Pack / $ 8.00
Total:
Trek / Price / Qty / TotalHandbook / $10.00
Journey / Price / Qty / Total
Handbook / $18.00
Grand Total:______
- All checks to be made out to Valley View Christian Church or VVCC.