Awana Clubs 2017-2018 Registration Form
$110

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Clubber Information

 
 
 
 
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Cubbies

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Sparks

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Please select all that apply.
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T&T

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Parent Information

 
 
 
Emergency Contact

 
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Medical

Please indicate below if there are any medical conditions or allergies we should be made aware of.
 
 
 
 
Cost

Club dues for the 2017-2018 Awana year are as follows:

$110 per child, regular registration. Max of $250 for 3 or more children.

This covers the cost of your clubbers book, shirt/vest, and bag for the entire year. For special payment arrangements, or scholarship requests, contact the church office at info@emcaz.org.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Estrella Mountain Church during Awana. In exchange for the acceptance of said child’s candidacy by Estrella Mountain Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Estrella Mountain Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in Awana sessions.

In case of injury to said child, I hereby waive all claims against Estrella Mountain Church including all leaders and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

On occassion, we may photograph a special event or activity for use in EMC or Awana publications including EMC's Facebook page. Please indicate your consent below. Please note,no response will default to Yes.
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Medical Release and Authorization

As Parent and/or Guardian of the named clubber, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named clubber. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Estella Mountain Church and its affiliates including Directors and Leaders to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of attended Awana events.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Description

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