AWANA Visitor | Registration

Visitor Registration Form (AWANA)

Visitor Registration Form | AWANA | Cornerstone Church |

AWANA is free of charge for all children
How did you hear about Cornerstone Awana? (State name of referring family, if any)
Date child/children will be attending Cornerstone Awana*
MM slash DD slash YYYY
How many kids will be visting AWANA?*
All children listed in this form must be from the same family.
First Child's Info
First Child's Name*
First Last
First Child's Date Of Birth*
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 Date Of Birth*
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 Date Of Birth*
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
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
How would you like us to follow up with you?
- Select All
- Text/SMS
- Email
- Phone
Please read and sign the waiver below for your child/ children.
Awana Hicksville Waiver Of Liability*
To be filled out by parents or legal guardians of participants under 18 years of age.

I do hereby release Cornerstone Church, (formerly known as India Pentecostal Assembly) 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 / children’s participation in AWANA program.
COVID-19 Safety Consent
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and as a result, social distancing is recommended. Awana Hicksville -Cornerstone Church will follow state and local standards of conduct and has put in place reasonable preventative measures to reduce the spread of COVID-19 at its Awana activities. However, even though such standards will be followed, and reasonable measures put into place, Awana Hicksville -Cornerstone Church cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Awana Hicksville -Cornerstone Church activity could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the Awana/Youth activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Awana Hicksville -Cornerstone Church may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Awana Hicksville -Cornerstone Church employees, volunteers, and program participants and their families. Considering the foregoing, however, I, grant permission for my child/ children, to participate in this program, notwithstanding the risks associated with the COVID-19 virus and group activities. I further agree on behalf of myself, my child / children named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, hold harmless, and defend Awana Hicksville -Cornerstone Church and their members, directors, officers, employees, agents and representatives (“indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the indemnitees’ in relation to prevention of the spread of the COVID-19 virus. I SPECIFICALLY ACKNOWLEDGE AND AGREE THAT I AM AGREEING TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE INDEMNITEES’ FROM THEIR OWN NEGLIGENCE IN REGARD TO THE INDEMNITEES’ NEGLIGENT ACTION AND/OR INACTION IN REGARD TO PROTECTION AGAINST THE COVID19 VIRUS. Virtual Meetings Consent

In order to continuously serve Awana clubbers during any potential Club closures, Awana Hicksville may provide distance-based, virtual programming for Club members, through which Club staff will facilitate program activities through online platforms. Awana Hicksville will use software, tools and applications provided by third parties that members, parents/guardians and/or staff will access via the Internet and use for purposes of communication and teaching. All communication will be through parents/guardians. Awana Hicksville will use Zoom, Email, Remind app and Facebook to interact and stay connected. This letter seeks consent for your child to utilize Zoom for distance-based, virtual Club program purposes. By signing this agreement, I, the undersigned parent and/or guardian of the Child/ Children named in this Form, a minor, give consent for my child/children to participate in Zoom meetings with their youth group and youth leaders. I understand that the youth leaders will be following Cornerstone Church safeguarding protocols at all times. I understand that I need to discuss with my child their participation in the Zoom meeting and agree any boundaries to their participation that I feel are appropriate.
Physical Meetings Consent

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 Cornerstone Church, 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 / Children named in this form, a minor, do release, acquit, discharge and covenant to hold harmless Cornerstone Church 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 Cornerstone Church 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 Cornerstone Church 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.

I give consent for my child/children to participate in Zoom meetings with their youth group and youth leaders. I understand that the youth leaders will be following Cornerstone Church safeguarding protocols at all times. I understand that I need to discuss with my child their participation in the Zoom meeting and agree any boundaries to their participation that I feel are appropriate .
- 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 Cornerstone Church to send me text alerts to my cell phone and email notifications as needed.
Consent – COVID-19 SAFETY*
I willfully acknowledge and agree that I am agreeing to defend, indemnify and hold harmless the Awana and Cornerstone Church, Inc from their own negligence in regard to the Awana Hicksville and Cornerstone Church’s negligent action and/or inaction in regard to protection against the COVID-19 virus. I provide my consent to have my child’s temperature taken via contactless temperature scan prior to entry. Awana Hicksville has the right to refuse entry if a parent or child has a fever or is exhibiting cold-like symptoms.
COVID-19 Isolation and Contact-Tracing
I further understand, in the event that I/my child(ren) is suspected or confirmed positive with COVID-19 or has come in close contact with a person suspected or confirmed positive with COVID-19, we will need to follow the CDC’s guidance for isolation or quarantine as appropriate. Information is available at www.cdc.gov. I agree to inform the Awana Hicksville administration as soon as possible, but no later than 1 business day, after learning of our suspected or confirmed positive case of COVID-19 and/or the need to quarantine due to close contact with a person suspected or confirmed positive for COVID-19. I understand that I/my child(ren) may not return to in-person Awana Hicksville activities until the child has tested negative for COVID-19, and an approval has been provided by Awana Hicksville leadership. Approval will be based on confirmation that the CDC’s criteria to discontinue home isolation or quarantine has been met.
Print Name*
Relationship To Child/ Children listed in this form*
Date*
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.

Visitor Registration Form (AWANA)

First Child's Info

Second Child's Info

Third Child's Info

Contact Information

Please read and sign the waiver below for your child/ children.