Clubber Registration

Lenexa Baptist AWANA 2017-2018

Option:  

Required  Price: 
Description: 
 = Required Field

 Clubber Information

 
 
 
 
  Select Month/Day/Year
 
 
 
 Grade ('17-'18): 
 Emergency Contact 
 Emergency # 
 Church  (if you regularly attend church which one?) 
Comments/Allergies 
 I am interested in helping: 


 WAIVERS

AUTHORIZATION AND RELEASE OF LIABILITY
I, the parent or guardian of the above-named child/children, 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, Lenexa Baptist Church and any persons involved in 
the Awana Club ministry.

MEDICAL CONDITIONS
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.

 

 

CONSENT TO PHOTO RELEASE 

I grant permission for photo(s) of my child/children to appear among other general club photos as long as there is no identifying information shown.


 CONTACT INFORMATION

GUARDIAN #1

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 
GUARDIAN #2

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 

 Refund Policy

For information about refunds please contact Clara Black at 913-627-9357.

 Contact Info