2008-09 Registration Form

In the Fall of this year, LIFE will start its first AWANA (Approved workmen are not ashamed) program for children ages 3 - High School. These weekly meetings wil be a time filled with energy, fellowship and spiritual growth, where your child(ren) will be invested in by trained staff and workers. AWANA blends Bible teaching, Scripture memory, and tons of fun as it assists churches in reaching children with the gospel of Jesus Christ and training them to serve Him. AWANA supplies programs, materials and training for more than 12,000 churches in over 110 countries. AWANA’s message to churches is simple: “We’re here to serve you with a ministry that is all about fun with a purpose -- to win and grow kids for Christ!” In order for your child(ren) to participate, we kindly ask that you fill out the pre-registration form below for each child. This will help us plan adequately and make sure your child gets in!

Parent/legal guardian Information:

First Name: Last Name:

Address 1:

City: State: Zip:

eMail Address:

Phone Number: Best time to call:

Emergency Contact:

Participating Child Information:

New to AWANA: Returning Clubber:

My friend invited me!

First Name: Last Name: Date of Birth (mm//dd/yyyy):

Grade: Gender: Age:

Does your child need an AWANA uniform? If so, what size?

Legal Matters:

In case of emergency and we are unable to reach a parent, please contact:

Emergency contact Name: Emergency contact Phone:

Does your child have any allergies we need to be aware of? If yes, please explain in detail in the space provided below:

Does your child take any type of medication? If yes, please list the medications used in the space provided below:

Medical Release Statement: Being the parent/legal guardian of the minor named herein, I hereby give Life Baptist Church and/or their representative(s) authority to secure any medical and/or surgical treatment for my son/daughter that they may determine necessary in the case of emergency, sickness, or accident.

Image Release Statement: During AWANA meetings and/or events related to AWANA, pictures of your child may be taken. By clicking the box on the left, you hereby consent and authorize Life Baptist Church or its assigns, to use your name and/or the names of your family members who are minors, as listed above, as well as your likeness, photos, videos and other information (or that of family members who are minors) for the purpose of news releases, advertising, publicity, publication or distribution in any manner whatsoever. I further consent to such use in their present form and to any changes, alterations, or additions thereto. I hereby release Life Baptist Church from all liability in connection with all such uses.

I acknowledge that the given information is correct and I agree to the above mentioned terms & conditions.

My signature: