Awana Club - Calvary Chapel Lebanon
Awana Club Calvary Chapel Lebanon 740 Willow Street Lebanon, PA 17046 (717) 273-5633 [email protected]
Registration Form age 3 to grade 6 Child's Last Name ________________________Child's First Name_____________________Boy/Girl (circle one)
Address ___________________________________________________________________________ Street City Zip code Home Phone ______________________Email ____________________________________________ Parent/Guardian's Name _________________________________ Cell Phone ____________________ Parent/Guardian's Name _________________________________ Cell Phone ____________________ Child's birthday _________________ Current Grade______Home Church_______________________ (dd/mm/yyyy) Please list any known allergies (environmental, dietary, and medications): _______________________ ___________________________________________________________________________________ Please note anything else that will help us as we teach your child:______________________________ __________________________________________________________________________________ If my child cannot be picked up with their dismissal ticket, the following have my permission to transport my child. A photo ID will be requested. 1. Name _____________________ Relationship to child __________________Phone_____________ 2. Name ______________________ Relationship to child _________________Phone______________ Emergency contact if neither parent/guardian listed above is able to be reached. Name________________________ Relationship to child ___________Phone__________________ The information given above is correct to the best of my knowledge. I give permission for my child to participate in the CCLebanon Awana program, for my child to be photographed for church-related materials (including but not limited to CCLeb website and Sunday announcements), and authorize CCLeb Awana to use their best judgment to treat my child in an emergency if neither parent/guardian nor emergency contacts can be reached.
SIGNATURE_________________________
Printed Name _____________________________
If there are any changes, additions, or deletions to the above information, please notify the CCLeb Awana Director in writing.
8/5/16
Registration Form age 3 to grade 6 Child's Last Name ________________________Child's First Name_____________________Boy/Girl (circle one)
Address ___________________________________________________________________________ Street City Zip code Home Phone ______________________Email ____________________________________________ Parent/Guardian's Name _________________________________ Cell Phone ____________________ Parent/Guardian's Name _________________________________ Cell Phone ____________________ Child's birthday _________________ Current Grade______Home Church_______________________ (dd/mm/yyyy) Please list any known allergies (environmental, dietary, and medications): _______________________ ___________________________________________________________________________________ Please note anything else that will help us as we teach your child:______________________________ __________________________________________________________________________________ If my child cannot be picked up with their dismissal ticket, the following have my permission to transport my child. A photo ID will be requested. 1. Name _____________________ Relationship to child __________________Phone_____________ 2. Name ______________________ Relationship to child _________________Phone______________ Emergency contact if neither parent/guardian listed above is able to be reached. Name________________________ Relationship to child ___________Phone__________________ The information given above is correct to the best of my knowledge. I give permission for my child to participate in the CCLebanon Awana program, for my child to be photographed for church-related materials (including but not limited to CCLeb website and Sunday announcements), and authorize CCLeb Awana to use their best judgment to treat my child in an emergency if neither parent/guardian nor emergency contacts can be reached.
SIGNATURE_________________________
Printed Name _____________________________
If there are any changes, additions, or deletions to the above information, please notify the CCLeb Awana Director in writing.
8/5/16
