Awana Registration

Awana-Logo
AWANA
Child's Name

Street Address*

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Allergies

Check and specify any reaction to the following

Any reason for limited activities?*

Current Medication Required?*

Past/Present Illness or Injury

Immunizations

In Case of Emergency

Address (if different than above)

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Insurance Information

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Insurance Address

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Parental Consent for Emergency Medical Treatment

I hereby understand and agree that neither Calvary Chapel Westgrove nor any of its staff or volunteers will be held responsible in the event of an accident or injury. In the event that my child requires medical attention, I hereby give permission for my child to be treated by a licensed physician. I understand that this medical release form may be updated as needed. However, I, the parent and/or legal guardian, assume full responsibility if any information is not current and updated for each event.

Media Release

I Hereby understand that while my child participates in AWANA Club that they may be photographed, video taped or otherwise recorded individually or within a group. I hereby grant permission and creative release to Calvary Chapel Westgrove for any media recordings of my child provided that they are strictly used for promotion and advertising that supports Calvary Chapel Westgrove and the children's ministry.

Media Release*