2020/2021 AWANA Registration

Hi — we're excited you're here to register your child for AWANA!

What You'll Need
Most of this is in your amazing brain, but you'll probably need your insurance card and phone to look up your emergency contact's number.

Thank you! We can't wait to hang out with your kids at AWANA!

Guardian Information

Name

Phone

This address will receive a confirmation email

Address

Pick-Up

Who may pick up your child(ren) after AWANA? (If blank, your chil(ren) will only be released to a parent.)

Emergency Contact

Parents are always our first contact in the event of an accident or emergency, so please do not put your or your spouse's name here. List an additional emergency contact.

Emergency Contact Name

Emergency Contact Phone

Relationship to child/children

Child's Information

Name

Gender

Male Female

Date of Birth

Grade

Food Allergies (please list and explain) and Medicines Currently Taking

Vest Size (children's sizes - only for 3yrs-2nd grade)

Focus Shirt size (for 3rd-5th graders)

2nd Child Information

Name

Gender Male Female

Date of Birth

Grade

Food Allergies (please list and explain) and Medicines Currently Taking

Vest Size (children's sizes - only for 3yrs-2nd grade) Medium Large XL XXL

Focus Shirt size (for 3rd-5th graders) Child's Medium Child's Large Adult Small Adult Medium Adult Large Adult XL

3rd Child Information

Name

Gender Male Female

Date of Birth

Grade

Food Allergies (please list and explain) and Medicines Currently Taking

Vest Size (children's sizes - only for 3yrs-2nd grade) Medium Large XL XXL

Focus Shirt size (for 3rd-5th graders) Child Medium Child Large Adult Small Adult Medium Adult Large Adult XL

Additional Notes

Medical Info

Hospital Insurance

Yes No

Insurance Provider

Policy #

Name of Insurance Policy Holder

Waiver · Release · Signature

Waiver Agreement

I authorize an adult, who cares for the minor, to transfer my child to the emergency room if a parent or emergency person cannot be reached. I consent to an X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment. I do not authorize the aforementioned waiver.

Photo/Video Release

I give permission for Oak Grove Church to use any photographs or videos taken of my child in, but not limited to slideshows, newspaper, web pages, social media, television, etc. I do not consent to use of my child's photo/video.

Consent to Report

By checking this box I consent to Oak Grove Staff to report suspicions of child abuse, elder abuse, and harm to self to the agencies, such as child protective services, a law enforcement agency, or Iowa's toll-free child abuse reporting hotline.

Text Communication

I give Oak Grove Church permission to send text message updates and reminders using the church’s Breeze app. (Note that texts are one-way, and will come from short code #: 96167.) I do not give permission to receive text messages.

E-Signature

By checking this box I acknowledge that I have read the above medical release and that all of the information contained in this registration form is true to the best of my knowledge.

Type Your Full Name

Registration Fee

Vest

Focus Shirts

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2020/2021 AWANA Registration

Hi — we're excited you're here to register your child for AWANA!

Thank you! We can't wait to hang out with your kids at AWANA!

Description

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