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Awana Club 2017-2018

Ages 3 years to 5th grade
Cost:$20 / child
AWANA begins September 13th

Please fill out the form below.  Please include first and last names of your children and please also include the age as well.

Child Name:*
Birthday:* (Format: mm/dd/yyyy)
Grade:*
Child Name:
Birthday: (Format: mm/dd/yyyy)
Grade:
Child Name:
Birthday: (Format: mm/dd/yyyy)
Grade:
Additional Children:
Parent Name (First & Last)*
Phone (home):*
Phone (mobile):*
Email:*
Spouse Name:
Spouse e-mail:
Spouse Phone Number:
Address*
Allergies:
 

I hereby authorize the staff and volunteers of Berkley Community Church to seek medical attendtion for my child, (or children) should an emergency arise, provided that I will be contacted as soon as possible.  Failure to reach me shall not prevent an application of immediate, necessary treatment not excluding injection, anesthesia, or surgery.  I further agree that Berkley Community Church shall not be held responsible fin the event of accident or injury, and in that regard.

I understand and agree that Berkley Community Church disclaims any and all liability in the unlikely event of injuries sustained in connection with Awana event of the church year 2016-2017.

The undersigned does also hereby give permission for our (my) child (or children) to ride in any vehicle designated by the adult in whose care the minor child has been entrusted while attending and participating in activities sponsored by Berkley Community Church.

I give permission for my child's picture to be taken and used in Berkley Community Church publications, advertising, or on the internet. No personal information will be included with the photo.

 
In the event of a medical emergency, I authorize Berkley Community Church and its staff to take my child/ren to the ER at William Beaumont Hospital in Royal Oak*
 

Please note by clicking Register, this will constitute an electronic signature of this form.

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What is the sum of five and three?*
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