Northside Baptist Awana Club Registration Form Club Year: 2009-2010 Please check only one Awana club Awana Camp After School (4:15 - 6pm) Evening (6:30 - 8:20pm) August 17-19 2009 Personal and Contact Information Parent/Guardian Name (*)- (at least one required) (*) Address 1 (*) Address 2 City (*) Zip Code (*) Emergency Contact during Club time (other than parent) Name(*): Phone(*): Family Church: Home Phone (*) Work Phone Cell Phone Email (*) I am interested in helping: Weekly Every Other Week Monthly For Special Events Note: All Awana Club Leaders and Listeners must submit to a background check before working with the children. Clubber Information (at least one child required) Name (*)(first and last) Nickname: Grade(*): Birthdate(*): Gender: M F Name (first and last) Nickname: Grade: Birthdate: Gender: M F Name (first and last) Nickname: Grade: Birthdate: Gender: M F Name (first and last) Nickname: Grade: Birthdate: Gender: M F Medical Info (allergies, medicines, special needs) Doctor's Name: Doctor's Phone: Comments/Suggestions: Terms and Conditions 1) I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Northside Baptist Church and any persons involved in the Awana Club ministry. 2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the Awana volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child. 3) I grant permission for photos of my child to be taken for in-church use only. 4) I grant permission for my child's Club Leader, Director, or Commander to periodically contact my child by mail, email, or phone. If a home visit is desired, my permission will be requested beforehand. 5) I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand. I have read the Terms and Conditions (*) I agree to the Terms and Conditions (*)

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