Registration | Registration For Events

Enrollment for 2019-2020 | AWANA | Cornerstone Church

AWANA is free of charge for all children
How Many Kids Are You Registering for AWANA*
First Child's Info
First Child's Name*
First Last
First Child's Gender*
First Child's Date Of Birth*
Date Format: MM slash DD slash YYYY
First Child's Grade Level*
PLEASE ACCURATELY PICK THE FIRST CHILD'S GRADE LEVEL BASED ON THE NEW SCHOOL YEAR
First Child's Allergies*
Second Child's Info
Second Child's Name*
First Last
Second Child's Gender*
Second Child's Date Of Birth*
Date Format: MM slash DD slash YYYY
Second Child's Grade Level*
PLEASE ACCURATELY PICK THE SECOND CHILD'S GRADE LEVEL BASED ON THE NEW SCHOOL YEAR
Second Child's Allergies*
Third Child's Info
Third Child's Name*
First Last
Third Child's Gender*
Third Child's Date Of Birth*
Date Format: MM slash DD slash YYYY
Third Child's Grade Level*
PLEASE ACCURATELY PICK THE THIRD CHILD'S GRADE LEVEL BASED ON THE NEW SCHOOL YEAR
Third Child's Allergies*
Contact Information
Address*
Street Address City State ZIP Code
Name of Parent(s)/Guardian(s)*
Home Phone*
Cell Phone*
Family Email*
Church You Attend
Primary Emergency Contact Relationship*
Primary Emergency Contact Name*
Primary Emergency Contact Phone*
Secondary Emergency Contact Relationship
Secondary Emergency Contact Name
Name
Secondary Emergency Contact Phone
Please read the Waiver below for your child(s).
Awana Waiver Of Liability*
To be filled out by parents or legal guardians of participants under 18 years of age.

I do hereby release India Pentecostal Assembly (IPA) of Hicksville, NY, their staff, leadership and volunteers from any and all claims and liabilities of whatsoever nature both individually and collectively, that may arise from my child’s participation in AWANA program.

In the event there arises an emergency necessitating medical, dental and/or surgical attention, I hereby consent and give my permission to the AWANA leaders of IPA, its representatives, or any attending physician to make such decisions and to perform such medical/dental treatments and/or surgery upon my child / children which may in their sole discretion be necessary and proper under the circumstances.

I, the undersigned parent and/or guardian of the Child's / Children's Name In This Form, a minor, do release, acquit, discharge and covenant to hold harmless IPA and AWANA leaders from any and all actions, damages or liabilities arising out of the treatment of any sickness or accident incurred by my said child(s) during this year’s AWANA program.

I understand that it is my responsibility to attend at least one of the parent orientation meetings and that failure to do so may disqualify my family from participation in AWANA.

I do hereby grant AWANA Hicksville and India Pentecostal Assembly permission to record, display and/or reproduce my child's / children's names, likeness and voices on audio and/or video tape, film or other media, to incorporate the media into any work product and to use or authorize the use of such media or any portion thereof in any manner or media by any means, methods or technologies now known or hereafter to be known.

I do hereby grant AWANA Hicksville and India Pentecostal Assembly permission to send me email alerts as well as text message updates, text alerts via applications including but not limited to Remind, Whatsapp, Google Suite Services and Planning Center Services. Text message alerts will be sent in case of weather related emergencies and for any other important alerts.
- Select All
- I Have Read & Agree To The Awana Waiver Of Liability for the stated children(s) above and I understand that I will manually sign this form at AWANA Hicksville.
- I permit Awana Hicksville and India Pentecostal Assembly to send me text alerts to my cell phone and email notifications as needed.
Print Name*
Relationship To Child/ Children listed in this form*
Date*
Date Format: MM slash DD slash YYYY
Signed Person's Phone*
Signature
BY DIGITALLY SIGNING THIS, YOU HAVE READ AND ACCEPTED THE AWANA WAIVER OF LIABILITY FOR THE STATED CHILDREN(S) ABOVE. NOTE THAT ALL FORMS MUST BE MANUALLY SIGNED BY THE PARENT BY COMING INTO IPA. ELECTRONIC SIGNATURES ARE NOT SUFFICIENT TO COMPLETE REGISTRATION PROCESS.
Name
This field is for validation purposes and should be left unchanged.

First Child's Info

Second Child's Info

Third Child's Info

Contact Information

Please read the Waiver below for your child(s).