AWANA 2008/2009 Online Registration Form

Ridgeway Alliance Church
465 Ridgeway
White Plains, NY 10605

Parent/Guardian Name 1:
First Last
Parent/Guardian Name 2:
First Last
Address:
Street (Include Apt or Unit Number)
City State Zip Code
Friday Night Contact Phone:
- (###) - ### ####
Primary Family Contact Email:
UserID@domain.domain
************************* Clubber 1 Information *************************
Clubber 1 Name:
First Last
Clubber 1 Birth Date:
/ MM / DD YYYY
Clubber 1 Gender:
Male Female
Clubber 1 Grade:
************************* Clubber 2 Information *************************
Clubber 2 Name:
First Last
Clubber 2 Birth Date:
/ MM / DD YYYY
Clubber 2 Gender:
Male Female
Clubber 2 Grade:
************************* Clubber 3 Information *************************
Clubber 3 Name:
First Last
Clubber 3 Birth Date:
/ MM / DD YYYY
Clubber 3 Gender:
Male Female
Clubber 3 Grade:
************************* Clubber 4 Information *************************
Clubber 4 Name:
First Last
Clubber 4 Birth Date:
/ MM / DD YYYY
Clubber 4 Gender:
Male Female
Clubber 4 Grade:

Terms and Conditions:

2) In the event of an emergency that requires medical treatment for the above named child/children, I understand that every effort will be made to contact me. However, if we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to an accident or treatment of my child/children.

3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information, to include the Ridgeway Awana web site at http://RidgewayAwana.org.

By Clicking "Submit" you have read and agree to the terms above.

AWANA 2008/2009 Online Registration Form

AWANA 2008/2009 Online Registration Form

************************* Clubber 1 Information *************************

************************* Clubber 2 Information *************************

************************* Clubber 3 Information *************************

************************* Clubber 4 Information *************************

* Clubber 1 Information *

* Clubber 2 Information *

* Clubber 3 Information *

* Clubber 4 Information *