Awana 2017-2018 Registration

Please fill out the form below to register for the 2017-2018 Awana program at Elim EFC. You will need to fill out one form for each child you are registering.

Student's First Name (required):

Student's Last Name (required):

Student's Gender:

Student's Age (required):

Student's Birthdate (mm-dd-yyyy) (required):

School Grade Level (beginning Sept. 2017):

Parent/Guardian First Name (required):

Parent/Guardian Last Name (required):

Address (required):

City (required):

Zip (required):

Phone/Cell Number (required):

Name of church you attend for worship:

Email:

Authorization to Consent to Medical Treatment for a Minor Child:

I hereby give permission to the medical personnel selected by Elim Evangelical Free Church to order x-rays, routine tests and treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transpiration for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Elim EFC to secure and administer treatment, including hospitalization, ambulance transport and paramedics for the person named above. I hereby agree to fully pay all costs of medical or dental care incurred by Elim EFC or their agent for the child under this authorization.

Health Problems/Allergies/Special Needs/Other Concerns:

Emergency Contact Name (required):

Emergency Contact Relationship (required):

Emergency Contact Phone Number (required):

Photography/Videography Release:

From time to time we like to share with our church family what is happening in Awana by capturing photographs and/or video. Sometimes a few of the pictures may appear in print material or on our website. We would like your permission for use of your child's image.

As parent(s) or legal guardian(s) of the above youth, your signature below gives Elim EFC the absolute right and permission to use your child's photograph(s) in its promotional materials and publicity efforts. We understand that the photograph(s) may be used in a publication, print ad, direct-mail piece, electronic media (e.g., DVD, video, Internet) or other form of promotion or information. We release Elim EFC, its agents, staff, and the photographer from liability for any violation of any personal or proprietary right we may have in connection with such use.

As the parent and/or legal guarding, do you accept that the information in this form is correct and you agree to BOTH statements above (Authorization to Consent to Medical Treatment for a Minor Child, and Photography/Videography Release)? Clicking "accept" is seen as equivalent to a written signature:
I accept

Now that you have submitted your registration (make sure to click the “Register” button when you finish filling out the form), you will also need to pay the registration fee. You can pay with a credit card online, here, or you can pay with cash or personal check on the first day of Awana. Please register your children before you pay the registration fee.