Seventh Street Baptist Church
School Year 2011-2012
Child’s Name Date of Birth School Grade Level
Address Home Phone
Mom’s Name Cell phone # Email address
Dad’s Name Cell phone # Email address
Does your family attend Sunday If “yes”, where do you attend Church?
Medical: Can photos of your child be placed on our
website? Yes No
Food Allergies Drug Allergies
Other Allergies Medical Needs
Daily Medications Special learning needs
Other special needs Any physical handicap or illness which would
prevent him/her from participating in normal
Custody issues: Do you give AWANA workers permission to
spray your child with mosquito repellent when
needed during outside play times? Yes or No
Emergency contact info: (name, phone number and relationship)
Who may pick up your child from AWANA other than you? Identification is required until
the person becomes known to AWANA leaders. This information will be confirmed by an
AWANA Leader and may not be changed without consent of the parent or guardian.
I, the undersigned parent/legal guardian of ______________________ (child’s name)
who is enrolled in the Seventh Street Baptist Church (SSBC) AWANA program, do hereby
release, forever discharge, and agree to hold harmless SSBC and the representatives
thereof from any and all liability, claims, or demands for personal injury, sickness, or
death, as well as property damage expenses of any nature whatsoever which may be
incurred by my child in the course of participation in the AWANA program. Furthermore,
I agree to assume all responsibility for any of the previously mentioned occurrences.
CONSENT AND CERTIFICATION
I, the undersigned, being the parent/legal guardian of the child named above, do hereby
consent to the participation of my child in all regularly scheduled activities of the AWANA
program of SSBC. I understand this may include activities such as AWANA Game Time,
field trips, campouts, swimming, parades, and any other activities associated with the
AWANA program. Further, I certify that my child is physically fit to participate in such
In the event of a medical emergency involving the child, as parent or legal guardian of my
child, I understand that I will be notified. However, if I cannot be reached, I hereby
authorize and give my consent for a leader of SSBC to administer appropriate first aid to
my child when needed or a designated representative of SSBC to call and consult a doctor
or medical facility for the evaluation and treatment of my child. I hereby authorize a
doctor or medical facility to provide the necessary treatment and procedures, including
anesthesia, which would be advisable in the event my child becomes injured or ill. I
further understand that SSBC will not be responsible for the medical expenses incurred,
but that such expenses will be my responsibility as parent/guardian.
I agree to notify the church in the event of any health changes that would restrict my
child’s participation in any of the activities normally associated with the AWANA program.
I further understand that the adult supervisors reserve the right to restrict my child
from any activity that they do not feel is within the physical capabilities of my child.
Signature of Parent/Guardian Date
State of Texas
County of Jefferson
On this the ________ day of ____________, 2011, before me, the undersigned
authority, personally appeared ________________________________, known to me to
be the person who executed the foregoing instrument, and acknowledged to me that
he/she executed same for the purposes therein stated.
Notary Public, State of Texas
For AWANA Office Use Only:
Registration rec’d ____________ Mailing List updated _________
Club Assignment _______________Leader __________________
Copy to club _________________
Seventh Street Baptist Church
Awana Club Rules
Drop-off & Pick-up
1. All children must be toilet-trained to participate in AWANA.
2. Please do not bring a child who appears to be ill or has been ill within the last 24 hours with fever,
vomiting, diarrhea or anything that may be contagious to another child.
3. Please bring your child(ren) to the Check-In Desk at 5:00 PM. Our club workers will not be available until
5:00 PM so please do not leave your child(ren) until the club leaders arrive. We begin Opening Ceremony
at 5:05 PM.
4. AWANA clubs dismisses at 7:00 PM. Please come inside to pick up your child as we will only dismiss
children to a parent or designated adult. Please make arrangements with the Commander prior to club as to
who will pick up your child. Your child’s safety is of extreme importance to us.
Respect to others & Property
5. Treats may be given to your child by his/her leader, but may not be eaten in the auditorium.
6. Respectful language, behavior, and dress are always expected. Pushing, shoving and rough-housing are not
7. Care and respect for church property must be demonstrated at all times.
8. Running is allowed only on the Game Circle during certain games. No running in the hallways.
9. We use a “5-count” for obtaining order. The clubber is expected to be waiting quietly for instructions.
10. We use a “3-count” for individuals who do not follow club behavior standards.
11. Tennis shoes or sneakers must be worn to participate in Game Time.
12. Upon receiving the uniform, the clubber should wear it to every regular AWANA meeting. Awards are
presented only to clubbers who are wearing uniforms.
13. Girls wearing dresses must wear shorts underneath; jeans are preferred.
Handbook and Game Time
14. Handbook sections must be passed by clubbers in one session. A maximum of two helps per section is
15. At least one handbook section must be passed every other club night. Clubbers who do not pass a
handbook section for two consecutive club nights will not be allowed to participate in the AWANA Store.
16. A complete liability release form is required for all children. Please know that we protect and care for your
child to the best of our ability; however, sometimes accidents happen and we must be prepared for such an
17. AWANA Clubbers are encouraged to regularly attend club and Sunday School. To receive club attendance
awards, attendance must comply with the AWANA club standards: no more than one un-excused club
absence per 8 week period and 2 un-excused Sunday School absences per 16 week period.
18. Clubbers earn the privilege to shop at the AWANA Store to spend their AWANA bucks earned through the
19. We have Theme Nights during the club year. Information for Theme Nights will be sent home with the
20. Special activities such as AWANA Games, Grand Prix, parades, will be scheduled. Your child is
encouraged to participate.