AWANA Registration! Fill out one registration per child. AWANA Registration AWANA Registration Terms & Conditions: 1. I understand if my child (children) are exhibiting any signs of a cold or the flu (runny nose, congestion, coughing, temperature, etc.) I will not bring them to the program during this time. 2. 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 risk of injury. I fully accept this risk, and hold harmless from any legal liability, Mt. Pisgah Wesleyan Church and any persons involved in the Awana Club ministry. 3. In the event of an emergency that requires medical treatment for the above-named child/children, I understand that every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to Awana volunteers to secure the services of a licensed medical professional 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. 4. I grant permission for photos of my child to be taken for in-church use, and for articles in the local newspapers. (Awards, Shoebox packing, Closing program). 5. I grant permission for my child’s club leader or program director to periodically contact me or my child by mail, email, or phone. Child's Name * Child's Name First First Last Last Birthday * Child's Age * Child's Grade * Parent/Guardian Name * Parent/Guardian Name First First Last Last Home Street Address * Home Phone City, State Zip * Cell Phone Emergency Contact Name * Emergency Contact Name First First Last Last Emergency Phone (Home/Cell) * Name of Doctor Doctor's Phone How did you hear about our AWANA Program? Please list names of person(s) who invited you, if any. List any allergies. (Food, medicine, bee Stings, etc.) List any other specific needs of which we should be aware. "I have read and agree with the AWANA 'Terms & Conditions' and have filled out the above info to the best of my knowledge." * Clicking here is the same as your signature! If you are human, leave this field blank. Submit