Participant's Name *
Participant's Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Home Phone
Home Phone
Cell Phone *
Cell Phone
Please note that our Sparks Clubs is full.
If your child has previously been in Awana, what handbooks have they completed? *
Participant's in 3rd grade - 6th (T&T) receive a T-shirt. If your child is a Cubbie or a Sparkie, pick from the vest options. If your child already has a vest or a shirt, please choose the first option.
This medical information may be necessary in the event of serious illness or accident. Please complete this part of the form accurately and truthfully. The facts you disclose will be kept confidential but will be made accessible electronically to the AWANA leadership at Calvary Chapel Eastside so that accurate medical information can be provided to medical professionals in an emergency situation. Failure to disclose accurate and complete information could compound the seriousness of an accident or illness so we urge both accuracy and completeness.
Health Insurance Phone Number *
Health Insurance Phone Number
Physician's Phone Number *
Physician's Phone Number
Name, phone number, relationship of a person to be contacted in case of an emergency when parent/legal guardian is unable to be reached.
Name, phone number, relationship of a person to be contacted in case of an emergency when parent/legal guardian is unable to be reached.
ist all over-the-counter and prescription medications, allergies to food or drugs, and describe any physical limitations that could affect your child's participation in physical activities pertaining to Awana. Write N/A if your child has none.
Terms & Conditions *
1) I understand that my child/children may participate in 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, and waive any claims against Calvary Chapel Eastside and any persons involved in the Awana Club ministry, including volunteers. 2) In the event of an emergency that requires medical treatment of 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 do hereby consent to any hospital, medical or surgical care and/or treatment, and the administration of anesthesia, determined by a physician to be necessary for my child's well being while under the custody and control of Calvary Chapel Eastside personnel or volunteers. I assume responsibility for all costs connected to any accident or treatment of my child. I agree to provide Calvary Chapel Eastside with an allergy and medication disclosure form for my child and I agree to keep such information current during the 2017-2018 Awana Club Year. 3) I grant permission for photos of my child/children to appear among other general club photos that will be taken throughout the club year and in Calvary Chapel Eastside's advertising at their discretion. 4) I grant permission for my child to be transported by the church or private vehicle to/from Awana Club events held during the 2016-2017 Awana Club Year. Any such event will be clearly communicated with me beforehand and will comply with the Calvary Chapel Eastside Children's Ministry manual.
Please type your name below as an electronic signature confirming that all information provided in this form is accurate and complete.