AWANA CLUB STUDENT ON-LINE REGISTRATION FORM
For children
3 years old by 9/30/07
through 6th Grade
Children MUST be potty trained
The Cubbies preschool class is now full. Please call 527-9753 to
have your child added to the waiting list. You will be called when a spot becomes available.
Registration Cost: Only $28.00 per child OR $60 for family of 3 or more. Due at check-in on September 5th.
(Registration covers the handbook and dues for the 2007-2008 Club Year)
Uniforms available at additional cost. Prices vary.
Financial Assistance available if needed.
Child's Name:
Birthdate:
GRADE:
Street Address:
City:
State:
Zip Code:
Parent or Guardian:
Home Phone Number:
Work or Cell Number:
Email Address:
Invited By:
Church you attend:
ALLERGIES/MEDICATIONS/SPECIAL INSTRUCTIONS
List all allergies:
Please list any
physical, emotional, or
behavioral
concerns/limitations
we should be aware of:
EMERGENCY CONTACT INFORMATION
Emergency
Contact Name:
Relationship to your
child:
Contact Phone:
PARENTAL CONSENT AND MEDICAL RELEASE
In signing this document, I hereby certify that I give permission to my son or daughter to
participate in AWANA CLUB at Cornerstone Christian Fellowship. I also authorize Cornerstone
Christian Fellowship to use photographs, video, and audio clips, including those of my son or
daughter in camp publicity.
In signing this document, I give consent for my child to receive emergency medical care if I
am unable to be reached.
You will also asked to sign a copy of this form at registration.
Parent or Guardian Signature
Date