Register Kids for AWANA 2017 (3 yrs - Grade 4)

Welcome to AWANA! $5 Early Bird Online Discount through September 1st! At Awana Wednesdays, clubs are for children from ages 3* through Grade 4. Ages are based on what age a child will be by September 30 and grades are based on the new school year. Fees remain the same all year (not pro-rated) since they are for your child's materials and equipment upkeep, so join any time, the sooner the better! Awana runs September 6 - May 2, 6:45 pm - 8:15 pm.


(*) 3-year-olds must be fully potty trained to enter Awana Cubbies (sorry, no pull ups). Otherwise, Awana volunteers may register their 3-year-old and younger children in Little Lambs (separate registration form on GraceKIDS page).
Family Info
Please complete all information for the parent/guardian and family to insure registration. Thank you for having your credit card ready after completing this page and moving to the club fees!
Make sure we have your correct email address so that you can receive important Awana updates, keeping you informed of what's happening in your child's club, as well as receiving a confirmation email for registration. Thank you!
Parent/Guardian First Name
Parent/Guardian Last Name
Address
City
State
Postal Code
Phone Number (The Best to Reach You)
Email Address (The Best to Reach You)
Do you have a church home? If yes, please enter the name of your church.
Full Name of an Emergency Contact/Additional Adult (In Case You Cannot be Reached)
Emergency Contact Phone Number
1st Child/Youth To Register
Please complete all information for your 1st child to ensure his/her registration
1st Child/Youth - First Name
1st Child/Youth - Last Name
1st Child/Youth - Gender
1st Child/Youth - Birthdate (mm/dd/yyyy)
1st Child/Youth - Age by Sept. 30 or Grade entering this fall
1st Child/Youth - Allergies: please list allergies we need to be aware of to help your child during VBS.
1st Child/Youth - Meds/EPI: Please list any medications and/or EPI Pens your child will/may need during VBS.

1st Child/Youth - Behavioral or Special Needs: please list issues we need to be aware of to help your child during VBS.

Adult (completing this form) relationship to this child
2nd Child/Youth To Register
Please complete all information for your 2nd child to ensure his/her registration
2nd Child/Youth - First Name
2nd Child/Youth - Last Name
2nd Child/Youth - Gender
2nd Child/Youth - Birthdate (mm/dd/yyyy)
2nd Child/Youth - Age by Sept. 30 or Grade entering this fall
2nd Child/Youth - Meds/EPI: Please list any medications and/or EPI Pens your child will/may need during VBS.

2nd Child/Youth - Allergies: please list allergies we need to be aware of to help your child during VBS.
2nd Child/Youth - Behavioral or Special Needs: please list issues we need to be aware of to help your child during VBS.

Adult (completing this form) relationship to this child
3rd Child/Youth To Register
Please complete all information for your 3rd child to ensure his/her registration
3rd Child/Youth - First Name
3rd Child/Youth - Last Name
3rd Child/Youth - Gender
3rd Child/Youth - Birthdate (mm/dd/yyyy)
3rd Child/Youth - Age by Sept. 30 or Grade entering this fall
3rd Child/Youth - Allergies: please list allergies we need to be aware of to help your child during VBS.
3rd Child/Youth - Meds/EPI: Please list any medications and/or EPI Pens your child will/may need during VBS.

3rd Child/Youth - Behavioral or Special Needs: please list issues we need to be aware of to help your child VBS.

Adult (completing this form) relationship to this child
Waivers
Media Waiver - I understand that my child(ren) may appear in media used by Grace Polaris Church including, but not limited to: images, video, audio, print pieces, social media, websites, and text. I consent to the collection and use of such media by Grace Polaris Church. I waive any rights, royalties, or other compensation arising from or related to the use of such media by Grace Polaris Church.
Medical Waiver - I agree to give my consent for emergency medical treatment for my child(ren) or myself. In the event of illness or injury requiring emergency treatment, I wish the Awana staff to seek treatment at the nearest available licensed physician or dentist, or transport to the nearest medical facility. I expect to be contacted as soon as possible if an emergency occurs. I hereby release Grace Polaris Church, its staff, volunteers and sponsors from any responsibility and liability for any illness or injury that the above mentioned child may sustain during any activity and any and all claims and liabilities.
Parent/Guardian Signature (to agree type First, MI, and Last name) - Media
Parent/Guardian Signature (to agree type First, MI, and Last name) - Medical
Almost Done - Important Details - please have a credit card ready
On the next page please select the Awana level (includes fee) for your child(ren), based on their club & if they are new or returning. Through Sept. 1 an $5 early bird online discount is provided when paying online . Then press "Order Now" once to complete the payment and registration process. Payment is required. A confirmation email will be sent to your email address. Please call 614-410-3246 if you do not receive a confirmation email or get an error message.
I understand I press "Submit" or “Pay for Event” ONLY ONCE on this page in order to continue my child(rens)'s registration and then select fees on the next page to pay by credit card so that my child(ren)'s registration will be completed.
Note: In order to continue your registration to the payment screens, please click the button below only once.
Awana Leaders only: At payment screen, use discount code PAL15 for 1 child; PAL30 for 2 children; PAL45 for 3.


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