AWANA Clubber Registration Club Year: 2008-2009 *Please pan to the left and right to see and complete all the required fields, the form will not submitt if all required fields are not completed.		Stamford Baptist Church AWANA Club 602 High Ridge Road Stamford, CT 06905
Parent / Guardian Name(s):  * required Address:  * required City:  * required State:  * required Zip Code:  * required Family Church:  * required Persons (other than parents) authorized to pick up the children:  * required			CONTACT Phone Numbers & E-Mail Home Phone:  * required Dad’s Work Phone: Mom’s Work Phone: Dad’s Cell: Mom’s Cell: Preferred E-Mail:  * required *Emergency Phone:  * required *Emergency Contact During Club Time (Other than parents)
Child's Name (First, Middle, Last)  * required		NICKNAME Birth Date Gender  * required  * required  * required	GRADE School Need Book Need Uniform  * required  * required
Clubber  * required	Doctor Name and Phone	Dentist Name and Phone	Allergies-Meds-Special Needs  * required
Terms and Conditions 1)  I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only.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 shown. 2) IN CONSIDERATION of being given the opportunity to participate in AWANA games and other activities sponsored by Stamford Baptist Church ("activities"), including scheduled and supervised activities, and any traveling to participate in these activities on or off the premises of Stamford Baptist Church ("SBC"), I, for myself and family, including my children who may be participating in these activities, hereby release and discharge SBC, the SBC  AWANA Club, AWANA Clubs International, their directors, officers, administrators, employees, agents, and volunteers, from all liability, claims, demands, losses or damages on my child's account caused or alleged to have been caused, in whole or in part by the negligence of the above named organizations and/or individuals, or by the owner and/or lessee of the premises on which these activities may occur, including negligent rescue operations; 3) AND I further agree that if, despite this release and waiver of liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any of the above-named organizations and/or individuals, I will indemnify, save and hold harmless each of such organizations and/or individuals from any litigation expenses, attorney fees, loss, liability, damage, or cost which may arise as a result of such claim, to the fullest extent permitted by law. 4) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/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 any accident or treatment of my child. 1)  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 shown. 2) IN CONSIDERATION of being given the opportunity to participate in AWANA games and other activities sponsored by Stamford Baptist Church ("activities"), including scheduled and supervised activities, and any traveling to participate in these activities on or off the premises of Stamford Baptist Church ("SBC"), I, for myself and family, including my children who may be participating in these activities, hereby release and discharge SBC, the SBC  AWANA Club, AWANA Clubs International, their directors, officers, administrators, employees, agents, and volunteers, from all liability, claims, demands, losses or damages on my child's account caused or alleged to have been caused, in whole or in part by the negligence of the above named organizations and/or individuals, or by the owner and/or lessee of the premises on which these activities may occur, including negligent rescue operations; 3) AND I further agree that if, despite this release and waiver of liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any of the above-named organizations and/or individuals, I will indemnify, save and hold harmless each of such organizations and/or individuals from any litigation expenses, attorney fees, loss, liability, damage, or cost which may arise as a result of such claim, to the fullest extent permitted by law. 4) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/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 any accident or treatment of my child. I Have read and agree to the Terms and Conditions stated above