EmailMe Form - Grace Chapel Awana Registration 2023-2024

Name of Clubber *

First Last

Date of Clubber's Birth *

MM / DD / YYYY

Gender

Male

Female

Allergies *

If Yes on Allergies, Please List:

School Grade Clubber will be in 2023/2024 *

Awana Club *

***Cubbies MUST be potty trained***

Parent/Guardian Name *

First Last

Cell# *

### - ### - ####

Confirm Cell #

### - ### - ####

Email *

Confirm email

Clubber's Address *

Street Address City State / Province / Region Postal / Zip Code

Alternate Emergency Contact Name: *

Alternate Emergency Contact Cell# *

### - ### - ####

Confirm Emergency Contact Cell #

### - ### - ####

Phone

### - ### - ####

Family Church

	Club Dues (mandatory) 1st child in family $55.00	Club Dues (mandatory) for Add'l Child in Family $40	Please send information on Volunteering	Please send me information on Scholarships
Registration Fee [NOTE: Scholarships available as needed.]

Book, Uniform, and Bag.

	Book - No Cost	Uniform Vest $11.25	Optional book bag $6.75
Cubbies (Ages 3-4) and Sparks (Grades K-2)

	Book - No Cost	Uniform Shirt $16.50	Optional book bag $13.00
T&T (Grades 3-6)

	Book - No Cost	Uniform Shirt $15.00	Optional book bag $13.00
Trek (Jr. High School)

We know this discount section can look confusing. We have structured it to give each family the largest discount possible based on the level of their volunteering. If you have questions, please send email to AWANAGCCR@gc-cr.org.

	1 Parent - 2 Nights - 25%	2 Parents - 2 Nights - 35%	1 Parent - Full time - 50%	2 Parents - Full time - 60%	Parent(s) in Director position - 75%
Discount for volunteers - First Child

	1 Parent - 2 Nights - 25%	2 Parents - 2 Nights - 35%	1 Parent - Full time - 50%	2 Parents - Full time - 60%	Parent(s) in Director position - 75%
Discount for volunteers - Add'l Child

TERMS and CONDITIONS

1) I understand that my child/children may participate in physical activities such as those held during game time. As with any physical activity, there is risk of injury. I fully accept this risk, and hold harmless from any legal liability, Grace Chapel Castle Rock and any persons involved in the Awana Club ministry.
2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or emergency contact. If I/we cannot be reached, I permission to Awana volunteers to secure services of a licensed medical professional to provide the care necessary for my child's well being. I assume resoponsibility for all costs connected to any accident or treatment of my child.
3) I grant permission for photos of my child to be taken for promotional and slideshow for special occasions.
4) I grant permission for my child's club leader or program director to periodically contact me by mail, email or phone.

I have read and agree to the terms stated above. *

I agree to the terms stated above

I do not agree. AWANA Ministry Director will contact you to discuss Terms and Conditions

Signature *

Clear