Awana, Cubbies, and Puggles Sign-Up

Parent/Guardian's Name

This address will receive a confirmation email

Phone

Address

Drop Off/Pick Up

FIRST and LAST NAME of who will bring your student to Awana each week (if other than parent/guardian listed above):

Please list FIRST and LAST NAME of anyone other than parent or guardian who may pick up your student:

Student Information

Student FIRST and LAST NAME

Birthday

Allergies (List N/A if none are known)

By checking this box, I am indicating that I DO NOT GIVE Permission for my child’s image to be used. Please do not photograph my child.

Cubbies (3's & 4's) only-Is this your first or second year in Cubbies?

In case of an emergency

Although it is our sincere desire to provide a safe environment for our children, we also recognize that accidents can, and sometimes do, happen. If such a situation should occur, our first response will be to contact you, the parent, unless it is a life-threatening injury where it would be wise to seek immediate medical attention. The purpose of this form is to allow us to obtain first aid care for your children if we are unable to contact you.

I give permission for my student to receive emergency medical treatment by professional medical personnel in the case of injury or illness while he/she is in the care of Harvest Time Bible Church during Awana.

Signed by:

Relation to child:

Payment

Required:
$20 fee to cover all expenses for the year (Puggles, Cubbies, Sparks, and HTK).

Optional
$10 tee shirt (Puggles ONLY)

All online prices include the fee charged to the church by the website to use online banking.

If you would like to pay in person, change payment to 0, and you will not have to enter your card information.

(Puggles ONLY) If you are ordering a shirt please indicate what size:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Awana, Cubbies, and Puggles Sign-Up

Description

Please Fix the Following