LVBC Awana Registration 2017-2018
Welcome to our online registration!
Primary Parent/Guardian
*
First Name
Last Name
Secondary Parent/Guardian
First Name
Last Name
Primary Contact Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Primary Phone
*
Phone Type
*
Cell
Home
WOrk
Secondary Phone
Phone Type
Cell
Home
WOrk
Home Church
*
Lebanon Valley Bible Church
We don't currently have a home church.
Other option
Child 1 Registration
Child 1 Name
*
First Name
Last Name
Child 1 Birthday
*
-
Month
-
Day
Year
Child 1 Age/Grade
*
Age 2
Age 3
Age 4
Age 5
K-5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
If attending school this fall, please indicate grade entering
Please list any allergies or special instructions for this child.
Was your child in Sparks last year?
*
Yes
No
Which book was your child in at the end of last year?
*
Book 1
Book 2
Book 3
Other option
Did your child finish that book?
*
Yes
No
Do you still have the book for your child to bring and finish this year?
*
Yes
No
Do you have another child to register?
*
Yes
No
Child 2 Registration
Child 2 Name
*
First Name
Last Name
Child 2 Birthday
*
-
Month
-
Day
Year
Child 2 Age/Grade
*
Age 2
Age 3
Age 4
Age 5
K-5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
If attending school this fall, please indicate grade entering
Please list any allergies or special instructions for this child.
Was your child in Sparks last year?
*
Yes
No
Which book was your child in at the end of last year?
*
Book 1
Book 2
Book 3
Other option
Did your child finish that book?
*
Yes
No
Do you still have the book for your child to bring and finish this year?
*
Yes
No
Do you have another child to register
*
Yes
No
Child 3 Registration
Child 3 Name
*
First Name
Last Name
Child 3 Birthday
*
-
Month
-
Day
Year
Child 3 Age/Grade
*
Age 2
Age 3
Age 4
Age 5
K-5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
If attending school this fall, please indicate grade entering
Please list any allergies or special instructions for this child.
Was your child in Sparks last year?
*
Yes
No
Which book was your child in at the end of last year?
*
Book 1
Book 2
Book 3
Other option
Did your child finish that book?
*
Yes
No
Do you still have the book for your child to bring and finish this year?
*
Yes
No
Do you have another child to register?
*
Yes
No
Child 4 Registration
Child 4 Name
*
First Name
Last Name
Child 4 Birthday
*
-
Month
-
Day
Year
Child 4 Age/Grade
*
Age 2
Age 3
Age 4
Age 5
K-5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
If attending school this fall, please indicate grade entering
Please list any allergies or special instructions for this child.
Was your child in Sparks last year?
*
Yes
No
Which book was your child in at the end of last year?
*
Book 1
Book 2
Book 3
Other option
Did your child finish that book?
*
Yes
No
Do you still have the book for your child to bring and finish this year?
*
Yes
No
Do you have another child to register?
*
Yes
No
Child 5 Registration
Child 5 Name
*
First Name
Last Name
Child 5 Birthday
*
-
Month
-
Day
Year
Child 5 Age/Grade
*
Age 2
Age 3
Age 4
Age 5
K-5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
If attending school this fall, please indicate grade entering
Please list any allergies or special instructions for this child.
Was your child in Sparks last year?
*
Yes
No
Which book was your child in at the end of last year?
*
Book 1
Book 2
Book 3
Other option
Did your child finish that book?
*
Yes
No
Do you still have the book for your child to bring and finish this year?
*
Yes
No
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Phone Type
*
Cell
Home
Work
Additional Notes?
Pick-Up Authorization
Other than parents/guardians listed above, how many individuals are authorized to pick-up your child(ren) after Awana?
*
0
1
2
3
4
5
Approved Pick-Up #1
First Name
Last Name
Approved Pick-Up #2
First Name
Last Name
Approved Pick-Up #3
First Name
Last Name
Approved Pick-Up #4
First Name
Last Name
Approved Pick-Up #5
First Name
Last Name
Policy Section
Please read the following policies. By clicking "Agree" you are agreeing to adhere to the policies for the 2017-2018 Awana year.
PHOTO RELEASE: I hereby grant permission to Lebanon Valley Bible Church, its officers, pastors, elders, deacons, trustees, employees, agents, representatives, successors, licensees, and assigns (hereinafter collectively referred to as “LVBC”), to photograph, record, or videotape (in any media) my child's image, likeness, depiction, testimony, or statement. I hereby grant permission to LVBC to edit, crop, alter, or retouch such photographs, recordings, statements, or digital images, and waive any right to inspect the final photographs, recordings, statements, or images. I hereby consent to and permit the photographs, recordings, statements, and images of me to be used by LVBC worldwide for any legal purpose, and in any medium, including print and electronic. I understand that LVBC may use such photographs, recordings, statements, or images with or without associating names thereto. I further waive any claim for compensation of any kind for LVBC’s use or publication of photographs, recordings, statements or images of me. I further waive any right or interest that I may have in such photographs, recordings, statements, or images, or the lawful uses to which they may be applied. I hereby grant to LVBC all rights to reproduce, display, and disseminate such photographs, recordings, statements, and images of me, in whole or in part, or altered in character or form, as well as related posters, websites, social media, presentations, programs, and publications. I further grant to LVBC all rights to make reproductions of such photographs, recordings, statements, and images through any media, for any lawful purpose. I also grant LVBC all rights of copyright to such photographs, recordings, statements, and images, and all rights to publish, market, or assign such photographs, recordings, statements, and images without compensation or report to me. I hereby fully and forever discharge and release LVBC from any claim for damages or claims of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) or any other cause of action arising out of the use or publication, distribution, modification and exhibition of photographs, recordings, statements, and/or images of me by LVBC, and covenant and agree not to sue or otherwise initiate legal proceedings against LVBC for such use or publication. All grants of permission and consent, and all covenants, agreements and understandings contained herein are irrevocable. I hereby represent that I am 18 years of age or older at the time of signing and have the full legal capacity to execute this Release. I further acknowledge that I have read this entire document, that I understand the contents, meanings, and impact, and that I have signed it knowingly and voluntarily.
*
Agree
EMERGENCY RELEASE: We hereby give permission for our young person to attend the children's activities sponsored or promoted by Lebanon Valley Bible Church, September 6, 2017 through September 5, 2018. In case of an emergency or if any medical treatment is necessary we hereby grant Lebanon Valley Bible Church and its adult representatives, a medical power of attorney to be used on behalf of our young person. We authorize and empower Lebanon Valley Bible Church and its adult leaders to utilize their decision in ordering or approving any medical treatment deemed necessary for our young person, by any licensed health care provider. We grant to the adult leaders the power to make all medical decisions and to authorize and approve all medical procedures in the manner as we could if we were personally present and required to make such decisions. We agree to reimburse Lebanon Valley Bible Church and its leaders for any expenses which the church or leaders may have incurred regarding any medical treatment for our young person. We understand that Lebanon Valley Bible Church is not responsible or liable for our young person's personal effects and property. We agree to hold Lebanon Valley Bible Church and the adult leaders harmless in the event of theft or loss resulting from any source or cause. We understand that this form is a blanket release that will be used for Awana activities sponsored or promoted by Lebanon Valley Bible Church, which our young person may attend. If at any time any information that we provided on this form changes we recognize that it is our responsibility to inform Lebanon Valley Bible Church of that change. We also understand that if we decide at any future date to invalidate this parental liability and medical release form we must do so in writing 10 days prior to any event in which our young person may be involved.
*
Agree
SICK CHILD POLICY: We are concerned for all children who attend Awana. Their health and safety is of the utmost importance to us. Therefore, we are asking that if your child did not attend school the day of Awana or is displaying signs of sickness including fever, vomiting, nausea, diarrhea, any contagious disease, open sores, or a questionable illness, that you please keep them home. If a child becomes sick while at Awana, we will contact you to come pick up your child.
*
Agree
ELECTRONICS POLICY: For the security of your personal property, we are enforcing a NO electronics/toys policy. If your child brings any of either kind, it will be taken and given back at the end of the evening.
*
Agree
BOOK POLICY: All children will receive one complimentary handbook each year. If that book is lost, there will be a $10 charge for a replacement book.
*
Agree
SAFETY POLICY: I understand that LVBC is committed to the safety of my child, and that all adult workers and helpers have been properly trained in compliance with Act 31 of Pennsylvania’s Child Protective Services Law, and have been approved only after undergoing a background clearance and proper training. I further understand, that adults who have not undergone the necessary requirements and have not been approved, may not stay with, or assist with the children during Awana except for special events in which parents have been specifically invited to attend. We look forward to a safe, fun year at Awana! Please contact the church office with any questions.
*
Agree
Parent Class Survey
LVBC is considering offering a class on Wednesday evenings for parents of Awana clubbers. Please select the topic(s) that would most interest you.
I would not be interested in attending a class.
Finances
Marriage
Parenting
Other option
SUbmit my Registration
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