LVBC Awana Registration 2017-2018

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	Country

Primary Phone *

Phone Type *

Secondary Phone

Phone Type

Home Church *

Lebanon Valley Bible Church We don't currently have a home church.

Child 1 Name *

First Name Last Name

Child 1 Birthday *

- Month - Day Year

Child 1 Age/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

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 Name *

First Name Last Name

Child 2 Birthday *

- Month - Day Year

Child 2 Age/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

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 Name *

First Name Last Name

Child 3 Birthday *

- Month - Day Year

Child 3 Age/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

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 Name *

First Name Last Name

Child 4 Birthday *

- Month - Day Year

Child 4 Age/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

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 Name *

First Name Last Name

Child 5 Birthday *

- Month - Day Year

Child 5 Age/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

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 Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

Phone Type *

Additional Notes?

Other than parents/guardians listed above, how many individuals are authorized to pick-up your child(ren) after Awana? *

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

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

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

LVBC Awana Registration 2017-2018

Child 1 Registration

Child 2 Registration

Child 3 Registration

Child 4 Registration

Child 5 Registration

Emergency Contact

Pick-Up Authorization

Policy Section

Parent Class Survey