EmailMe Form - CrossWinds Church AWANA Registration

EmailMeForm

Family Last Name *
First Child's Information
Please enter information of the 1st child.
Child (1) Name *
Child (1) Age *
Child (1) Date Of Birth *
MM / DD / YYYY
Child (1) Grade in Fall *
Child (1) Allergies/health issues
Second Child's Information
Please enter information of the 2nd child.
Child (2) Name
Child (2) Age
Child (2) Date of Birth
MM / DD / YYYY
Child (2) Grade in Fall
Child (2) Allergies/health issues
Third Child's Information
Please enter information of the 3rd child.
Child (3) Name
Child (3) Age
Child (3) Date Of Birth
MM / DD / YYYY
Child (3) Grade in Fall
Child (3) Allergies/health issues
Misc Information
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Phone Number
### - ### - ####
Email
Emergency Contact *
Emergency Phone Number *
### - ### - ####
Mother's Name
Mother's Cell Phone Number
### - ### - ####
Father's Name
Father's Cell Phone Number
### - ### - ####
Guardian's Name
Guardian's Cell Phone Number
### - ### - ####
Home Church
Parent permission slip:
**The undersigned being the parent or legal guardian of the above named children hereby saves and holds harmless CrossWinds Church and youth sponsors, jointly, severally, personally and each and every one of them, from acts or act and all claims or liabilities arising from the participation of said children in the activities described as follows- CrossWinds indoor and outdoor AWANA activities or in transportation provided to and from said activity. The undersigned hereby authorizes the correct authorities to consent to any medical care treatment, which may be necessary due to any personal injury or illness of said children while attending or enroute to said activity.
Signature for Permission *
Doctor Name
Doctor Phone#
### - ### - ####
Insurance Company
Insurance Policy#
Permission to photograph you child:
From time to time we take pictures during activities, at CrossWinds Church. We would like your permission to use these pictures on our website, in our newsletters/pamphlets, or during slideshows. We will never reference your child by name or provide any specific information regarding your child. We also will never sell these pictures; we will use them exclusively for CrossWinds Church.
Please take a moment to let us know your preferences regarding our use of photos of your children: *
YES. I grant you permission to use photos of my child at CrossWinds Church website, slideshow, and /or newsletter/pamphlets.
NO. Please do NOT take or use any photos of my child.
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First Child's Information

Second Child's Information

Third Child's Information

Misc Information

Parent permission slip:

Permission to photograph you child: