Registration Forms

Virginia Beach Free Will Baptist Church

AWANA CLUB 2009-2010 REGISTRATION FORM

Parent/Guardian:

Name(s): _______________________________________

Address: _______________________________________

City: _____________ State: ________ Zip: ____________

Family Church: ___________________________________

Persons (other than parents) authorized to pick up child(ren):

______________________________________________

Child’s Name (First, Middle, Last): Birth Date:

1 ____________________________ ______________

2 ____________________________ ______________

3 ____________________________ ______________

4 ____________________________ ______________

5 ____________________________ ______________

Doctor’s Name and Phone:

_____________________________________________

Number/Email address Contact Person

Home Phone: ___________________ ______________

Cell Phone: _____________________ ______________

Work Phone: ____________________ ______________

E-Mail: _________________________________________

Emergency Contact:

______________________________________________

Gender: Grade: Need Book Uniform

1 ________ _______ □ □

2 ________ ________ □ □

3 ________ ________ □ □

4 ________ ________ □ □

5 ________ ________ □ □

Medical Info (allergies, meds, special needs):

______________________________________________

Terms & Conditions

1) I understand that my child(ren) 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 Virginia Beach FWB 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(ren), I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give 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 cost connected to any accident or treatment of my child.

3) I grant permission or a photo of my child to appear on our Awana website as long as no identifying information is shown.

4) I grant permission for my child(ren) to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated beforehand.

5) PUGGLES specific only: As a parent or legal guardian of a child in Puggles, I (or my spouse), will remain at the church at all times during club night. I will make known of my where abouts to the Puggles leaders.

I have read and agree to the Terms and Conditions stated above.

__________________________________________________

ONE FORM PER FAMILY, if possible.

Make checks payable to: VBFWBC marked AWANA w/clubbers name in memo area.

Awana Enrollment and Dues Policy: Children are considered enrolled when all dues are paid, all forms are submitted, and there are enough volunteers to staff the classroom. Scholarships for the 2009/2010 Awana Club are available; please contact us for more information.

I am interested in helping:

___ Weekly ___ Monthly ___ For Special Events

Note: All Awana Club leaders and listeners must submit to a background check before working with the children.

_______________________________________________

REGISTRATION FEES:

Yearly: $25 per clubber ($75 maximum fee per family)

DUES: per week $ .50

annually $18

Registration fee includes clubber Uniform and Handbook.

Uniforms are awarded AFTER child completes entrance booklet (except Puggles).

Completed applications can be turned in during Check-In on Wednesday evenings.

Questions?? Call 757-499-3536 or email Amy Atchison (AWANA Commander) commander@vbfwbcawana.org