Cornerstone Baptist Church - Williston - Awana Registration Form

Name of Guardian:

Relationship to Child:

Phone Number

Name of Guardian:

Relationship to Child:

Phone Number

Do you attend church?
Yes
No

Do you attend Cornerstone?
Yes
No

Name of Church (if other than cornerstone)

Emergency Contact 1:

Phone Number

Relationship to Child:

Emergency Contact 2:

Phone Number

Relationship to Child:

Name of Child 1:

Age:

Grade:

Gender:
Male
Female

Birthday:

Allergies (if none, state none) or Special Information (medications or activity restrictions):

Club:
Cubbies (3-PreK)
Sparks (K-2nd)
T&T (3rd-5th)

Name of Child 2:

Age:

Grade:

Gender:
Male
Female

Birthday:

Allergies (if none, state none) or Special Information (medications or activity restrictions):

Club:
Cubbies (3-PreK)
Sparks (K-2nd)
T&T (3rd-5th)

Name of Child 3:

Age:

Grade:

Gender:
Male
Female

Birthday:

Allergies (if none, state none) or Special Information (medications or activity restrictions):

Club:
Cubbies (3-Prek)
Sparks (K-2nd)
T&T (3rd-5th)

Name of Child 4:

Age:

Grade:

Gender:
Male
Female

Birthday:

Allergies (if none, state none) or Special Information (medications or activity restrictions):

Club:
Cubbies (3-Prek)
Sparks (K-2nd)
T&T (3rd-5th)

1) I consent to and approve my child's taking part in any and all activities conducted by AWANA and/or CORNERSTONE BAPTIST CHURCH ("CHURCH"), which activities may include off- property excursions. I also understand that participation in this activity may include automobile transportation. I release, hold harmless and indemnify AWANA and the CHURCH, their respective agents, employees, volunteers, officers, and directors from any and all liability, costs, and claims arising from my child's participation in AWANA and the CHURCH. 2) I consent to the treatment of any minor injuries of my child and release, hold harmless and indemnify AWANA and the CHURCH and their officers, directors, agents, employees, and volunteers from any and all liability, claims and costs arising from or growing out of such treatment. 3) I hereby grant Cornerstone Baptist Church AWANA Club the right to copyright, reproduce, publish, and otherwise use my child's photograph in any and all media, for purposes of advertising and promoting Cornerstone Baptist Church AWANA Club. I hereby waive any causes of action I may have because of the use of my child's photograph and/or name. (Type your name below to agree)

Payment Method ($30 per child):

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