Holly Brook Baptist Church - Register Clubber

Welcome to online registration

Please enter any allergies in the Special Notes section.

New Awana Registration

Household Information

Parent/Guardian #1 *

Relationship

Parent/Guardian #2

Relationship

Address *

City *

State *

Zip *

Enter alternate address for Parent/Guardian#2

Phone# *

Other Emergency Contacts (include phone numbers)

Please include a phone# and name for each of your Other Emergency Contacts.

List others authorized to pickup your child

What church do you attend?

Church attendance is NOT required. Enter NONE if you don't attend a church.

I don't have an email address

Email *

Child Information

First Name*

Last Name*

Gender*

Registration Type*

Grade for 2023-24*

Birthdate*

Attendance Type*

Invited by

Special Notes

Please enter any special notes that we should know about your child. For example, allergies, special instructions, etc.

Medical Release: As a parent/guardian, I give my permission for the above minor to attend Awana activities including regular club nights and any special activities from September 4, 2020 to May 1, 2021. I authorize treatment under the direction of any licensed physician of the above minor in the event of a medical emergency which in the opinion of the attending physician my endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted after reasonable effort has been made to reach me by phone. I will not hold the church, or their staff, administration, or workers, liable for any injury to or loss of possessions by the above minor during any activity either on the church property or away, including regular meetings as well as special events.

YES, I give permission as stated above for my child regarding medical care

NO, I do NOT give permission for my child to receive medical care

In lieu of your signature, please enter your initials:

Photo Release: Photographs are sometimes taken of Awana ministry activities for publicity and promotional purposes, which include, but are not limited to, in-house presentations, church web site, brochures and newsletters. By signing below, you are granting the church to use photographs of the above mentioned minor(s) as stated.

YES, I grant permission for use of photographs of my child as stated above

NO, I do NOT authorize use of photographs of my child

In lieu of your signature, please enter your initials:

Covid-19 Release: Exposure to COVID-19 is an inherent risk in any public location where people are present. I acknowledge that any procedures put in place by the church will not eliminate the risk of COVID-19 and I accept the risk of the above minor participating in this activity.
(This text can be changed via Admin->Customize Clubber Form. Click the Properties link next to this field on that page.)

YES, I consent to the above

In lieu of your signature, please enter your initials:

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