AWANA Leader Registration - South River Baptist Church

Leader's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth (the year will be kept private)*

Gender*

Home Church*

Cell Phone Number*

Email Address*

Home Phone Number*

Work Phone Number

Other Phone Number

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Awana Service History

(example: Sparks Leader from 9/2004 to 9/2006 at East Madison Baptist Church)

Club (Sparks, Trek, etc.)	Role (Director, Leader, etc.)	Dates or Club Years	Church Name	Note

Training History

(example: Cubbies Basic Training Completed 8/2007)

Description of Training/Events	Dates	Note

Medical Information

Allergies, Conditions, Special Needs or Concerns

Service Opportunities

Select those you are interested in serving in.

Clubs

Role

Are your trusting Jesus as your personal Savior?*

Are you a member at South River Baptist Church?*

How long have you been a member?*

All volunteers are subject to background check before working with our clubbers and your Driver's License and Social Security Number will be required.

Terms and Conditions*

I agree to be bound by the bylaws and policies of South River Baptist Church and to refrain from unscriptural conduct. I will commit myself to one (1) year of service to the Awana program at South River Baptist Church and participate in tithing program to help support this ministry. I agree to consent to a background check. I understand that these terms and conditions are to ensure a safe and secure environment for our clubbers. I further state that I have carefully read the foregoing release and know the content thereof and I sign this release as my own free act.

I have read and agree to the Terms and Conditions stated above (signature required below)

Signature*

Service Opportunities

All volunteers are subject to background check before working with our clubbers and your Driver's License and Social Security Number will be required.

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