Grace Evangelical Free Church
Longmont, Colorado
AWANA  2011 Registration Application Form

Dues is $25 per child for the Awana season
Please fill out completely before submitting online. 
CHILD INFORMATION
Child's Name:
Gender: Boy     Girl  
Address:
City: State:  Zip:
Home Phone:
Cell Phone:
Tuesday Night Contact #:
Birth date:
Grade (as of Fall 2011):
Attended Last Year? Yes      No
Parent/Guardian's Name:
Please call me about volunteering
Home Church:
Email:
(required in order to receive weekly updates)
AWANA CLUB PERMISSION SLIP
My child has my permission to attend AWANA activities sponsored by Grace Evangelical Free Church. I will not hold Grace Church, nor any of its AWANA leaders, responsible for any injuries the above named clubber may incur while participating in club activities on Tuesday nights, while traveling to or from or participation in any AWANA sponsored events.

As a parent (or guardian), I do hereby authorize the treatment by a qualified & licensed medical doctor, of the above named minor, in case of a medical emergency that may, in the opinion of the attending physician, endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after every reasonable effort has been made to reach me.

This release form is completed and signed of my own free will, with the sole purpose of authorizing medical treatment, under emergency circumstances, in my absence.
The effective date of this release is from August 23, 2011 through May 22, 2012.
EMERGENCY  CONTACT INFORMATION
Doctor:     
Phone:
If I/we cannot be reached, please contact:
Name:     
Phone:
Please state any specific conditions that we should know concerning the health of your child, that is: allergies, chronic illness, etc.
Who is NOT allowed to 
pick up your child? 
DUES $25 dues will be collected  per child for the Awana season.

  Date

  Digital Signature of Parent or Guardian (enter your initials)

Ready to submit your child's registration? 
[Please submit one form per child]

Please Click the button and WAIT for the page to show your registration application has been successfully generated.  Automatic confirmation does NOT guarantee your child a place in the AWANA program for 2011/12.  Placing will be determined by the number of adult leaders we have available for the program.  

If you do not receive confirmation, please call Rod Brunson or Kerry Moodey at the church office (303)772-5685 or email Rod at rbrunson@graceefc.org to confirm receipt of your child's information.

Click to transmit your information
to Grace Evangelical Free Church