Awana Registration 2018-2019 (Payment by Credit Card)
Scotts Hill Baptist Church - 185 Scotts Hill Loop Rd. Wilmington, NC 28411
{{ Cognito.resources['order-transaction-details-header'] }}
{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}
| {binding Group} | |
| {binding Name} - {binding Description} | {binding displayValue} |
| {{ Cognito.resources['payment-subtotal'] + ":" }} | {binding displayValue} |
| {{ Cognito.resources['order-total-label'] }}: {binding displayValue} | |
| {{ Cognito.resources['order-amount-paid'] }}: | ({binding displayValue}) |
| {{ Cognito.resources['order-balance-due-label'] }}: | {binding displayValue} |
Parent / Guardian Information
Parent / Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Primary Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Emergency Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Please fill out your child's information. If you have multiple children then please check the box after each child to add additional children.
Child's Information
Child #1
Child's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Birthdate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Grade {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child #1 Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Each Child Registered is a separate $30 fee that includes all their materials for the year.
Child #2
Child's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Birthdate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Grade {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child #2 Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Birthdate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Grade {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child #3 Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Birthdate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Grade {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child #4 Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child' Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Nickname {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Birthdate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Grade {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child's Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Child #5 Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Terms and Conditions
1) I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Scotts Hill Baptist Church and any persons involved in the Awana Club ministry.
2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child.
3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information shown.
4) I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand.
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }