RLMC AWANA Registration Form 2023-2024
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What AWANA Club will your child be a part of? (Please choose from the list below.) *
Child's First Name *
Child's Last Name *
Date of Birth *
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Gender *
Age *
Grade *
School Attended (submit "none" if younger than school age) *
Food Restrictions, Allergies, Etc. *
CONTACT INFORMATION
Child's Home Address (including city/state/zip) *
Father's First Name *
Father's Last Name *
Father's Phone Number *
Mother's First Name *
Mother's Last Name *
Mother's Phone Number *
Preferred Phone Number *
Preferred email address *
Church Regularly Attended (if any) *
Are you connected to the "RLMC AWANA" Facebook Page?                *If you are not connected to this FB page, there will be an invitation link on your screen after submitting this registration. Please consider connecting to the RLMC AWANA Facebook page as this is where regular announcements, cancellations, and monthly newsletters are posted. *
If parents are not available, please list an additional emergency contact:
Name of Additional Emergency Contact *
Relationship to the child *
Phone Number(s) *
As a parent/guardian, I hereby grant my permission for the above-named student to participate in AWANA activities throughout the year from September 13, 2023 through September 11, 2024 under the direction of adult leaders of the Richfield Life Ministries Church. I understand that my student will be required to follow all policies and procedures put in place by the Richfield Life Ministries Church Administration Team and will be exposed to the spiritual truths of the Bible. I also give permission for my student to appear in photographs that may be used to promote the AWANA program of the Richfield Life Ministries Church. *
MEDICAL RELEASE AWANA Activities from Sept. 13, 2023 to Sept. 11, 2024]                                                                                                               As a parent/guardian, I herewith authorize medical treatment, under the direction of any licensed physician, of the above minor, in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, or cause disfigurement, impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me at the numbers listed above. I, the undersigned, assume the responsibility for any costs connected with such treatment and hereby release the Richfield Life Ministries Church and its AWANA staff members from any liability thereof. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
By clicking the box below, I agree with and accept the terms & conditions of the RLMC AWANA Registration form and Medical Release section. I confirm that I have read and completed the RLMC AWANA Registration accurately. *
Today's Date *
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Optional: If you have any questions or comments for the RLMC AWANA Staff please include them below.
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