Emmanuel Baptist Church 3309 Sweetwater Dr.

Rock Springs, WY 82901

AWANA REGISTRATION FORM 2013-2014

Childs Name:__________________________________________ Nick Name: _________________ Gender : ****Cubbies must be 3 years old by September 5th, 2013 and must be potty trained**** Birth Date: _______ /_______ /________ Age (on Sept 5th): ___________ School Grade (on Sept 5th):__________ M F

Street Address : _____________________________________________________________________________________ City : _____________________________________ Home Phone: _________________________________ State: ________________ Zip Code: ____________________

Cell Phone: _________________________________________

Parent/Guardian Name(s): ____________________________________________________________________________ Email Address: _________________________________________________ Home Phone: _________________________________ Cell Phone: __________________________________________ Address (if different then childs): ______________________________________________________________________ City : _____________________________________ State: ________________ Zip Code: ____________________

*Emergency Contact: Name: _____________________________________ Phone: _____________________________

* During AWANA club time, other than parent(s)

Church that you regularly attend, if any:

Emmanuel Baptist Church

Other _______________________________

Photographs are sometimes taken of childrens ministry activities for publicity and promotional purposes, which include, but are not limited to, in-house presentations, church web sites, brochures and newsletters. Childrens names or information are never used without specific permission. Please indicate below if you are allowing Emmanuel Baptist to use photographs of your child as stated above or not. Yes, photographs MAY be taken of my child. No, DO NOT take any photographs of my child.

MEDICAL INFORMATION
Allergies (food and medications) : ______________________________________________________________________ Medical Conditions: _________________________________________________________________________________ Medications (currently taking): ________________________________________________________________________ List any special concerns you have about your child or any information that would be helpful for their leader to know:__ __________________________________________________________________________________________________ __________________________________________________________________________________________________

I understand that my child may participate in physical activities such as those held during Game Time. As with any physical activity, there is risk of injury. I fully accept this risk and hold harmless from any legal liability, Emmanuel Baptist Church and any persons involved with the AWANA Club ministry. 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 we cannot be reached, I am indicating below whether I give or do not give my permission to the AWANA Club volunteers to secure the services of a licensed physician to provide the care necessary for my childs well being. I assume responsibility for all costs connected to any accident or treatment of my child. In EMERGENCIES requiring IMMEDIATE medical attention, your child will be taken to nearest hospital emergency room. My selection below indicates my decision to give or not to give my permission for a responsible person from Emmanuel Baptist Church to have my child transported to that hospital and receive treatment. I have read and AGREE to the terms and conditions stated above. I DECLINE authorization for a responsible person from Emmanuel Baptist Church to seek medical attention for the above named child. Parents/Guardians Signature: ____________________________________________ Date: ____________________

PARENT VOLUNTEER
We need your help to fulfill the vision of this ministry. You may choose when you volunteer and what you would like to do. Without volunteers AWANA would not be possible. We have a volunteer schedule located in the hall outside of the sanctuary on the bulletin board. Please sign up for any area where you are willing to help. I am interested in helping: Weekly Every other week Monthly For Special Events

Name: ___________________________________________ Phone Number: __________________________________

AWANA ANNUAL DUES AND FEES

Listed below are the 20133-2014 AWANA dues and fees. Please note that there were some price increases. These fees include everything the clubber requires for the ministry year. The annual dues are $20 which covers partial costs of awards, AWANA store, snacks, and other miscellaneous things throughout the year. However, the AWANA Grand Prix will be a separate fee as it is optional for clubbers to participate. Clubbers will be responsible for replacement books and uniforms. Clubbers are also responsible for additional books and extra credit cards (sparks only) that they need during the year as the annual fee only covers one book. Your child will need a new handbook if they are starting AWANA for the 1st time, if they are entering a new club (ie: Cubbies to Sparks or Sparks to T&T), if they are entering 5th Grade in the T&T program, if they completed their handbook last year, if they are a Cubbie (Cubbies need a new book each year). Your child will need a new uniform if they are starting AWANA for the 1st time, if they are entering a club (ie: Cubbies to Sparks or Sparks to T&T), if they are entering 5th Grade in the T&T program.

**Each child is required to have a handbook and uniform** Annual Dues and fees - $42 (includes 1 Handbook, 1 uniform, awards, & annual dues) $32 without book (includes 1 uniform, awards, & annual dues) $30 without uniform (includes 1 handbook, awards, & annual dues) $20 without uniform and book (includes awards & annual dues) AWANA Grand Prix - $10 (includes car kit and trophy) -- ** AWANA Grand Prix is optional** Replacement Books - $10 Replacement Uniforms - $12
We want all clubbers to be able to attend AWANA and have books and uniforms. If the cost of these items would impose a financial hardship for your family, please contact the AWANA commander, Melinda Wright (307-389-1938). AWANA scholarships are available. We do not want to lose any children because of a monetary problem.

2013-2014 ORDER/PAYMENT FORM

Please select which you child needs: $42 (includes 1 Handbook, 1 uniform, awards, & annual dues) $32 without book (includes 1 uniform, awards, & annual dues) $30 without uniform (includes 1 handbook, awards, & annual dues) $20 without uniform and book (includes awards & annual dues) Payment Method: Cash Date paid: ______ /________ /________ Check Please make check to Emmanuel Baptist Church and put AWANA in the memo. Date paid: ______ /________ /_______ Payment Plan I will pay _$___________ each month for a total of _______ months. (This monthly payment can be given to the AWANA
commander or can be mailed to Emmanuel Baptist Church, but make sure to put AWANA and the child's name on the check)

Check #: _____________

Date paid: ______ /________ /________ Date paid: ______ /________ /________ Date paid: ______ /________ /________ Date paid: ______ /________ /________ Date paid: ______ /________ /________ Date paid: ______ /________ /________ Date paid: ______ /________ /________ Scholarship

Amount Paid: Amount Paid: Amount Paid: Amount Paid: Amount Paid: Amount Paid: Amount Paid:

$____________ $____________ $____________ $____________ $____________ $____________ $____________

Check #: _________________ Check #: _________________ Check #: _________________ Check #: _________________ Check #: _________________ Check #: _________________ Check #: _________________

**Please contact the AWANA commander for scholarships**