CLUBBER INFORMATION

(List names from youngest to oldest of all children living in the same household)

PAYMENT INSTRUCTIONS:
Make a check payable to CEFC and mail to address below. Please write AWANA Registration in the check memo.

2420 Blakeslee Blvd. Dr. West, Lehighton, PA 18235

You can also bring your payment to the first meeting.

CEFC LIABILITY RELEASE

In consideration of Christ Evangelical Free Church (herein referred to as CEFC) allowing the Participant in CEFC AWANA Ministries, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless CEFC, its employees, and its volunteers from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage expenses of any nature whatsoever which may be incurred by the undersigned and the Participant, hereby grant our (my) permission for the Participant to participate fully in CEFC events.

Furthermore, we (I) [and on behalf or our (my) minor Participant] hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in all activities involved therein. The undersigned agrees to hold harmless and indemnify CEFC for any liability sustained by CEFC as a result of negligent, willful or intentional acts of Participant, including expenses incurred attendant thereto.

MEDICAL TREATMENT PERMISSION

We (I) authorize an adult in whose care the minor Participant has been entrusted, to consent to any emergency x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to the minor Participant under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility.

The undersigned shall be liable and agree(s) to pay all cost and expenses incurred in connection with such medical and dental services rendered to the aforementioned minor Participant pursuant to the authorization. Every effort will be made to call the parent / guardian first before resorting to assuming medical treatment, unless there is a life-threatening emergency.

PARENT/GUARDIAN AUTHORIZATION

Please check the box on the left and insert your full name and the date you are submitting this form.

Please Note:

Checking the box and adding my name below to this consent/liability release/medical permission form it is an acknowledgement that I have read and understand these guidelines. I recognize that this is a medical release, and liability release for the entire 2024-2025 AWANA Club year.