Cubbies Registration

	Puggles Awana Registration Puggles is currently full. You may register to be put on a waiting list, but please do not pay until we let you know there is room in the class
First Name
Middle Name
Last Name
Address
City
Zip
Phone
Church
Birthdate	(e.g. xx/xx/xx)
Gender	Male Female
Age	2 1/2 3 3 1/2
Parent/Guardian
Work Phone
Adults Authorized to pick up your child
Name
Phone
Name
Phone
Please list any additional family members that attend club and the club they attend

Medical Release
	My child has my permission to participate in Awana Club activities and field trips for the 2007-2008 school year. I hereby authorize the leadership at Christ the King Community Church to seek medical attention for my child in case of an emergency when I cannot be reached. I also agree not to hold Christ the King Community Church liable in the event of an accident or injury. I also understand that by providing my initials and pressing the Submit button below, it qualifies as my electronic signature in this registration. In case of emergency a CTK staff member may: 1. Administer First Aid. 2. Call emergency phone numbers: ; 3. Call my child’s doctor. Dr. at phone Please be aware of the following medical concerns:

Parent/Guardian Initials
Date