Family Information

Your Name (required)

Your Email (required)

Address (required)

City (required)

Province (required)

Postal Code (required)

Primary Phone Number (required)

Secondary Phone Number

Name(s) of authorized pickup (required)

Family Doctor (required)

Home Church

Preferred Bible Version (required)

—Please choose an option—KJVNKJVNIV

Please indicate below if you give consent to use your child’s picture. This may be for prayer cards, end of the year slideshow, or in promoting the club on the website or social media. We try our best to honour this request but under certain circumstances your child may be visible in certain large group pictures regardless of your response here. (required)

—Please choose an option—YesNo

Children Information

There is space for additional children if needed. First child is required. If you do not need to enter any additional children just leave the spaces blank.

Child 1 Information

Name (required)

Birthdate, format is YYYY-MM-DD (required)

Gender (required)

Grade on September 1, 2022 (required)

Health Card Number(required)

Allergies or Special Needs

Child 2 Information

Name

Birthdate, format is YYYY-MM-DD

Gender

Grade on September 1, 2022 (required)

Health Card Number

Allergies or Special Needs

Child 3 Information

Name

Birthdate, format is YYYY-MM-DD

Gender

Grade on September 1, 2022

Health Card Number

Allergies or Special Needs

Child 4 Information

Name

Birthdate, format is YYYY-MM-DD

Gender

Grade on September 1, 2022

Health Card Number

Allergies or Special Needs

Child 5 Information

Name

Birthdate, format is YYYY-MM-DD

Gender

Grade on September 1, 2022

Health Card Number

Allergies or Special Needs

Additional Comments

Agreement

• Fairhaven Bible Chapel Awana club will do their best to follow the guidelines given by Saskatchewan Health Authority and we expect that parents and clubbers will do their best to follow these guidelines as well. Failure to follow these guidelines may result in dismissal from the club. Any fees or donations will not be returned.

• I understand that my child/children 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, Fairhaven Bible Chapel, and any persons involved in the AWANA Club ministry.

• In the event of an emergency that requires medical treatment for my registered child/children, 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 services of a licensed physician to provide the care necessary for my child's/children's well being. I assume responsibility for all costs connected to any accident or treatment of my child/children.

• I understand that regardless of my wishes my child may have their photo taken in some large group photos and such photos may be used to promote the Awana club.

• I understand that this is just a pre-registration form and that this will allow the Awana leadership to pre-fill a hard copy of the Awana registration that I must sign during registration. Awana registration is due before clubbers are given a club book or uniform. Cost is $45 per clubber or $120 maximum per family.