Awana Online Registration (pay later) Awana 2017-2018 Registration (pay later) Child's Name* First Last Mailing address*City, State, Zip*Gender*MaleFemaleBirthday* Grade for the 2017-2018 school year*Preschool (3 & 4 years old)Kindergarten1st2nd3rd4th5th6thSchool AttendingParent/Guardian InformationParent / Guardian Name* First Last Email Home or primary phone number*Father's Work or Cell PhoneMother's Work or Cell PhoneWhat is your preferred way to communicate? (call, text, email, etc)Would you be interested in: Helping each week as a listener during book time (1/2 hour commitment) Helping at AWANA once a month Helping prepare for and run a special event (store, drive in movie, grand prix, games) Taking photos at AWANA on special nights Helping during AWANA with secretarial needs Finding out about additional ways to serve at AWANA Emergency Contact Person Name* First Last Emergency Contact Person Phone Number*Home Church (if any)Medical InformationDoctorDoctor's Phone NumberAllergies* No Known Allergies Foods Drugs Insect bites/stings Other Explain any allergiesIs tetanus shot current?*YesNoAre there any physical activity restrictions?*YesNoPlease explain any restrictions.Are there any medical conditions we should be aware of?InsuranceOur church insurance is only secondary insurance. If you have insurance, your carrier will be billed for medical charges in the case of illness or injury while at Awana. Is the child covered by health insurance?*YesNoInsurance Carrier NameInsurance Policy NumberAddress of Insurance companyMedical ReleaseIn the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by a Skyline Church Representative to hospitalize, to secure proper treatment, and/or order an injection, anesthesia or surgery for my son or daughter as deemed necessary.Liability ReleaseBy signing this form, the parent/guardian agrees to assume and accept all risks and hazards inherent in Awana and agree not to hold Skyline Baptist Church, or any of their staff or volunteers liable for damages, losses or injuries to the person or property under-signed. The Parents/guardians understand that they are signing for the minor listed on this form and the signature is both for medical and liability release. In addition, the parent or guardian hereby authorizes Skyline to use, reproduce, distribute and display their child's image and photograph, as well as any video, digital, or audio recording or reproduction, in connection with external and internal communcations of the church.Parent/Guardian Signature*By typing in your full name you are "signing" your consent to the Medical and Liability releases and giving your child permission to participate in Awana.Today's Date* CommentsThis field is for validation purposes and should be left unchanged.