AWANA Cubbies Registration Form 2017-18
 
AWANA Cubbies Registration Form 2017-18
Child's Last Name  * 
Child's First Name  * 
Boy or Girl (please make selection)  * 
Mailing Address (Street or PO Box)  * 
City  * 
State  * 
Zip Code  * 
Child's Birthdate i.e. (00/00/0000)  * 
Child's Age at time of Registration  * 
Child's Grade for 2017-18 School Year  * 
Does your child have any allergies? If none, please write none.  * 
Cubbies accepts only potty-trained 3 & 4 year olds. Is your child potty-trained?  * 
Parents First & Last Name(s)  * 
Parents Cell Phone Number  * 
Phone number where you can be reached during AWANA  * 
Secondary emergency Name & Phone Number  * 
Church You Attend - If none, please write none.  * 
Cubbies Registration Fees (includes annual dues, Cubbies Book and Cubbies vest)  * 
If you already have a Cubbies vest, you may deduct the value of the vest. If you do not have a Cubbies vest, please select "Need Vest".  * 
You can have an optional Handbook Bag.  * 
If you cannot be reached in the event of an accident or emergency, do you authorize a church representative to make arrangements for your child to receive medical care?  * 
Do you fully release & hold harmless TEMPLE BAPTIST CHURCH, its volunteers & staff from all liability for any accident, injury or death caused in attendance at any AWANA activity?  * 
Do you grant Temple Baptist Church permission to electronically display your child’s picture on our new Facebook page?  * 
Do you authorize the physician named below to provide care and treatment for your child as deemed necessary in the event of an accident or medical emergency?  * 
Physician's Name & Phone Number  * 
Do you attest that adequate insurance is in effect to cover your son or daughter while attending all AWANA activities?  * 
Insurance Provider & Group/Health ID #  * 
Your Email Address  * 
Total $
 
 
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