Awana Registration

Parent/Guardian Name *

First

Last

Cell Phone *

###-###-####

Home Phone

###-###-####

Email *

Address *

Street Address, City, State, Zip

Home Church

Emergency Contact Name *

First

Last

Emergency Contact Number *

###-###-####

Person(s) other than Guardian authorized to pick up your child(ren) (must be 18 years or older):

Child 1's Name *

First

Last

Nickname

Age *

Grade *

Birthdate *

MM/DD/YYYY

Allergies or Special Needs

Check all that apply.

Need book
Need uniform

Uniform size (if needed)

Child 2's Name

First

Last

Nickname

Age

Grade

Birthdate

MM/DD/YYYY

Allergies or Special Needs

Check all that apply.

Need book
Need uniform

Uniform size (if needed)

Child 3's Name

First

Last

Nickname

Age

Grade

Birthdate

MM/DD/YYYY

Allergies or Special Needs

Check all that apply.

Need book
Need uniform

Uniform size (if needed)

Terms and Conditions *

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 and hold harmless from any legal liability Chinese Christian Church Baltimore and any persons involved in the Awana Club Ministry.
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 designated emergency contact person. If I/we cannot be contacted, I give permission for the Awana volunteers to secure appropriate medical care as necessary for my child’s well-being. I assume responsibility to all costs associated with any accident or treatment of my child.
I grant permission for photos of my child/children to be used for in house presentations, brochures, and newsletters so long as no identifying information is shown.
I understand that checking this box and entering my full name below constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Parent/Guardian Signature *

First

Last

Date *

MM/DD/YYYY

Comment

Note: Costs per child are $30 for a uniform and handbook. Please bring cash or a check with you if you would like to purchase these for your child(ren).

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1800 Cromwell Bridge Road, Parkville MD 21234 | 410.823.8258

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