AWANA Registration - South River Baptist Church

The Awana Club Program begins September 11th and will be at 5pm each Sunday nights (some Holidays we don’t meet) in the Family Life Center at South River Baptist Church.

Are you interested in helping as a leader? If so, please use this link to express your interest. We will contact you for next steps > Leader Form

Child's Name*
First Last
Child's Nickname
Date of Birth*
Month
Day
Year
Age*
Gender*
Grade just started*
School*
Allergies? If so, please specify
Special needs? If so, please specify
Book/Uniform Needs
- Need Book
- Need Uniform
Parent/Guardian Name Primary*
First Last
Address Primary*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Name Secondary (if needed)
First Last
Address Secondary (if needed)
Street Address Address Line 2 City State ZIP Code
Home Church*
Persons (other than parents) authorized to pick up the child:*
Cell Phone Contact Name*
First Last
Cell Phone Number*
E-mail Contact Name*
First Last
Email Address*
Home Phone Contact Name*
First Last
Home Phone Number*
Work Phone Contact Name
First Last
Work Phone Number
Other Contact Type and Name
First Last
Other Phone Number
Emergency Contact Name During Club Time (other than parents)*
First Last
Emergency Contact Phone Number During Club Time (other than parents)*
Terms and Conditions*
- I have read and agree to the Terms and Conditions stated above (signature required below)
- I have read and DO NOT agree to the Terms and Conditions stated above (signature required below)
1) I understand that my child may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, South River Baptist Church and any person involved in the Awana Club ministry. 2) In the event of an emergency that requires medical treatment for the above named child. I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the Awana volunteers to secure the care necessary for my child's well being. I assume responsibility for all cost connected to any accident or treatment of my child. 3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information shown. 4) I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand.
Signature*

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