AWANA Registration Form 2024-2025 Club Year
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New Prospect Baptist Church
310 Ms-305, Olive Branch, MS 38654
662-893-6722
www.newprospect.net
Registration Form Club Year 2024-2025
Please print legibly
Parent(s)/Guardian(s) Name: _____________________________
Mom Cell #_____________________
Home Address: _______________________________________
Dad Cell #______________________
_______________________________________
Email address: (required) ________________________________________________________________
Emergency Contact (Other than parent)____________________ Emergency Contact #________________
Name of who is authorized to pick up your child(ren)____________________________________________
Child’s Name
1.
Date
of
Birth
Grade
or F
Puggles
2 - 3 yr
olds
Cubbies
3yr -PreK
(Must be 3
by 8/31)
Sparks
K-2nd
T&T
3rd—6th
Registered
in Database
(office use
only)
2.
3.
4.
Medical & Allergy Information
Child’s Name
Allergy
Medica-
tions
Sensory
Issues?
1.
2.
If you checked yes for sensory issues, please explain to help us serve your child:
_____________________________________________________________________________________________________________
Release or Liability, Photo Use, and Medical Consent for Treatment
1. Release of Liability. I, for myself, my minor child and for the child’s other parent and/or guardian, hereby release, waive, discharge, and covenant
not to sue New Prospect Baptist Church, and its officers, employees, agents, volunteers, heirs, and assigns of and from all liability, loss, claims,
demands, possible cause of action, court costs, attorneys’ fees and other expenses arising from any lawsuit that may otherwise occur from any
loss, damage, or injury to my child’s person or property in any way resulting from or connected with my child’s attendance at Awana, including
without limitation the failure of anyone to enforce rules and regulations, failure to make inspections, or the negligence of other persons.
2. Photo Release. I give permission for my child’s photo, which may be taken during Awana, to appear on the church website (newprospect.net),
Facebook Awana Group, Facebook Church Page or be used for publicity or display purposes. _________YES _____________NO
3. Consent to Medical Treatment . In the event of an emergency that requires medical treatment for any of the above named children, I understand
every effort will be made to contact me. However, if I cannot be reached, I give my permission to Awana volunteers to secure the services of a
licensed physician to provide care necessary for my child’s well being. I assume responsibility for all costs connected to any accident or treatment
of my child.
Signature of Parent/Guardian________________________________________________ Date_______________________
Name of Participant:_______________________________
Club Costs
Puggles
Cubbies
Sparks
T&T
Items Given
Handbook
(Cubbies
include vests)
10
20
10
10
Dues
15
15
15
15
Bag/Backpack
(Optional)
10
10
10
15
Total without
bag
$25
$35
$25
$25
Total with
everything
$35
$45
$35
$40
Max per family $65
TOTAL AMT
(Circle what was purchased and write cash, check #, or Tithely)
Name of Participant:____________________________________________________
Club Costs
Puggles
Cubbies
Sparks
T&T
Items Given
Handbook
(Cubbies
include vests)
10
20
10
10
Dues
15
15
15
15
Bag/Backpack
(Optional)
10
10
10
15
Total without
bag
$25
$35
$25
$25
Total with
everything
$35
$45
$35
$40
Max per family $65
TOTAL AMT
(Circle what was purchased and write cash, check #, or Tithely)
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