Awana Registration Form – Oakhurst EVFree

Oakhurst Evangelical Free Church

AWANA CLUB

REGISTRATION FORM 2022-2023

Awana Child Registration
Parent(s) Name*
Email*
Day Phone*
Cell Phone
Mailing Address*
Home Church
Number of Children Being Registered*
Please enter a value between 1 and 5.
Register Clubbers
Clubber Name*
Birthday*
Grade*
Gender*
Clubber Name
Birthday
Grade
Gender
Clubber Name
Birthday
Grade
Gender
Clubber Name
Birthday
Grade
Gender
Clubber Name
Birthday
Grade
Gender
Emergency Contact
In case of an emergency and the parent or guardian cannot be reached, who would be contacted?
Primary Contact Name*
Relationship to Child*
Address*
Phone*
Secondary Contact Name
Relationship to Child
Address
Phone
Medical Information
Medical Insurance Carrier
Policy #
Please list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:
Acceptance and Comments
We hereby release the Oakhurst Evangelical Free Church and the above mentioned AWANA Clubs Program and/or AWANA Clubs leaders from liability in case of injury or illness to the above named Child(ren). The above named child(ren) has my permission to participate in the activities in the above named AWANA Clubs Program. In the event that I/we cannot be reached in the event of an emergency, I give my permission for necessary medical care, to secure proper treatment and to order injections, anesthesia or surgery for the above named child(ren). I understand that all billings for service not billed to my insurance carrier will be billed to me as a parent/guardian.
*
- I understand and agree to the above terms of service.

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