Awana REGISTRATION
Child’s Name _____________________________________Prefers/Nickname______________________
Address _______________________________________ City/State/Zip ____________________________
Home Phone ________________________ Birth Date __________________
Father (Guardian)
 Boy
 Girl
Mother (Guardian)
Name
Cell Phone
Work Phone
Email Address
What phone number should we use? _____________________________________________________
Grade________________________
List any food allergies or health concerns _________________________________________________
Health History (please check all that apply)
 Hay Fever
 Insect Sting Allergy
 Heart Conditions
 Diabetes
 Physical Handicap
Any Activity Restrictions?
 Nervous Disorders
 ADD/ADHD
 Asthma
 Chronic Digestive Problems
(List) ___________________________________________________________________________
Custody Concerns?  Yes Please notify class leaders regularly. Please include relevant details regarding custody
or security concerns
__________________________________________________________________________________________
Behavioral Concerns  Yes _______________________________________________________________
__________________________________________________________________________________________
Name of Church Regularly Attended ___________________________________City_______________
Pastor’s Name _________________________ How Often Does Family Attend ___________________
Awana Enrollment and Dues Policy: There is a cost for Awana enrollment, these dues help cover the
cost of awards, the Awana store and activities throughout the year. The first handbook is provided by
the church; however if the handbook is lost, damaged beyond repair or clubber completes and
starts another handbook, an additional cost of $8.00 is required before they receive a new
handbook. If financial assistance is needed please contact Sardis Baptist Church at 568-3996.
Limited/Full scholarships may be available. Typically a scholarship is ½ cost of the annual due. To
receive full benefits of this program, pre-payment or financial assistance must be received at the
beginning of the program.
Release Form for Use of Personal Images (Pictures / Videos)
From time to time during the club year videos, photographs, and/or slides will be taken of our
Clubbers. These will be used for publicity purposes only. Your signature below grants permission for
Sardis Baptist Church to use videos, photographs, and/or slides of your child for publicity purposes
and/or publishing to our website.
___________________________________________
_____________________________
Name of Parent/Guardian
Date
Emergency Medical Treatment Consent (must be signed by parent or legal guardian)
I, ________________________________________________, do hereby state that I am the (a) parent and/or
guardian having legal custody of the minor child listed on front page. I give consent for a responsible
adult at the Awana clubs at Sardis Baptist Church (SBC) to administer appropriate first aid to my child
when needed. I also give consent to secure additional emergency treatment for my child, under the
following conditions: reasonable effort has been made to find me at the church or at home, SBC
volunteers, the commander or SBC staff determines that care is needed prior to probable return of
the parent/guardian to pick up the child. I understand it is my responsibility to notify the classroom
leaders as to where I can be reached in the event of an emergency.
________________________________________________________________
Parent/Guardian Signature
______________________
Date
We realize that no activity is without the possibility of unforeseen hazards which could result in injury to
an individual. For this reason, Sardis Baptist Church provides supervision and directions for the safe
conduct of activities. Sometimes these directions are not followed or are disregarded by children in
our program resulting in injury. As a parent or other responsible person, Sardis Baptist Church expects
you to be aware of your responsibility to instruct your child of the importance of conduct which will
insure safety and an enjoyable time. ______________ (Your Initials)
By signing this form you as a parent, guardian or other responsible person agree to assume the risks
and hazards which may be inherent in all activities, you also agree to absolve and hold harmless
Sardis Baptist Church and/or it’s owners, agents or employees for damage, losses or injuries to their
person(s) or property undersigned. Sardis Baptist Church carries accident insurance as secondary
insurance to individual or family coverage. I do hereby release, forever discharge and agree to hold
harmless Sardis Baptist Church and the directors thereof from any and all liability, claims or demands
for personal in injury, sickness or death, as well as property damage and expenses, of any nature
whatsoever which may be incurred by the undersigned and the participant that occur while said
person is participating above described activity. The undersigned further hereby agrees to hold
harmless and indemnify said church its directors, employees and agents for any liability sustained by
said participant, including expenses incurred attendant thereto.
____________________________________________________
Parent/Guardian Signature
____________________________________________________
Date
Club Use Only
Registrar: ____________________ Date: _____________________ Total Paid$ _____________________
Check # ___________/Cash Name ______________________________
Awana
Club
 Cubbies (ages 3 & 4)
 T&T 3rd & 4th grades
 Sparks – K-5, 1st & 2nd grades
 T&T 5th & 6th grades