Awana Registration

* Parent/Family LAST NAME:

* Parent FIRST NAME:

I am a regular attender of CBFC

* Address:

* City:

* State & Zip:

Email:

* Phone:

Cell Phone:

* Emergency Contact(s) if parent cannot be reached (name and phone):

In case of emergency, I understand that every effort will be made to contact a child's parent or guardian. In the event I cannot be reached, I hereby give permission for emergency treatment for the listed child(ren) in my care. In case of an accident, I hereby release Calvary Bible Fellowship Church, any staff members, and/or volunteer from liabilities.

I agree with the above statement

* Child's Name:

* Child's Birthdate (mm/dd/yyyy):

* Grade Level for 2010-2011 school year:
Select OnePre-K (4 & 5 yr olds)Kindergarten1st2nd3rd4th

Medical Alterts/Allergies or Special Needs:

* I verify that the above allergies/special needs are correct (please initial):

2. Child's Name:

Child's Birthdate (mm/dd/yyyy):

Grade Level for 2010-2011 school year:
Select OnePre-K (4 & 5 yr olds)Kindergarten1st2nd3rd4th

Medical Alterts/Allergies or Special Needs:

I verify that the above allergies/special needs are correct (please initial):

3. Child's Name:

Child's Birthdate (mm/dd/yyyy):

Grade Level for 2010-2011 school year:
Select OnePre-K (4 & 5 yr olds)Kindergarten1st2nd3rd4th

Medical Alterts/Allergies or Special Needs:

I verify that the above allergies/special needs are correct (please initial):

4. Child's Name:

Child's Birthdate (mm/dd/yyyy):

Grade Level for 2010-2011 school year:
Select OnePre-K (4 & 5 yr olds)Kindergarten1st2nd3rd4th

Medical Alterts/Allergies or Special Needs:

I verify that the above allergies/special needs are correct (please initial):

5. Child's Name:

Child's Birthdate (mm/dd/yyyy):

Grade Level for 2010-2011 school year:
Select OnePre-K (4 & 5 yr olds)Kindergarten1st2nd3rd4th

Medical Alterts/Allergies or Special Needs:

I verify that the above allergies/special needs are correct (please initial):