AWANA Clubber Registration

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2008-2009 Clubber Registration

To register your child(ren) for the Awana program at Woodmen Valley Chapel, please complete the form below. After clicking the "submit" button at the end of the form, you will be directed to the online payment portion (myWVC) of the registration. Each child is $25, with a maximum family cost of $75.

*Online Payment must be received for your registration to be valid.

Each form is valid for up to four (4) children. If you are registering for five or more Clubbers, please fill out the information for the first four, then resubmit this form for the remaining children.

* Campus  
* Parents/Guardians  
* Address  
* City  
* Zip Code  
* Home Phone  
Cell Phone  
* Email  
Home Church  
* Parents Location on Wed. Evenings  

* Child 1 Full Name  
* Gender  
* Birthday (mm/dd/yyyy)  
* Grade - Fall 2008  
* Club Assignment  
Medical Conditions or Allergies  


Child 2 Full Name  
Gender  
Birthday (mm/dd/yyyy)  
Grade - Fall 2008  
Club Assignment  
Medical Conditions or Allergies  


Child 3 Full Name  
Gender  
Birthday (mm/dd/yyyy)  
Grade - Fall 2008  
Club Assignment  
Medical Conditions or Allergies  


Child 4 Full Name  
Gender  
Birthday (mm/dd/yyyy)  
Grade - Fall 2008  
Club Assignment  
Medical Conditions or Allergies  


MEDICAL RELEASE: In the event of an emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby authorize an agent of Woodmen Valley Chapel to act on my behalf to seek emergency medical treatment for my child in the event that such treatment is deemed necessary by that agent. I authorize the physician selected by said agent to administer such emergency treatment as said physician deems necessary (in his/her judgment) under the circumstances. I understand and agree that I will be responsible for payment of said physician's fee and any and all other fees or expenses associated with such treatment. I hereby release Woodmen Valley Chapel, its agents and employees from any and all claims and liabilities resulting from adherence with these instructions.

* I agree with these terms and conditions  

* Electronic Signature-type your name:  

* I verify that my electronic signature is valid  

 


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