AWANA 2026-2027 Youth Leader Registration

PARENT INFORMATION

Parent Name

Best Phone

This address will receive a confirmation email

Youth Leader Leader Information

This section is for youth leaders who would like to serve ONLY, and do not wish to continue on with Trek or Journey Books.

Child Name (First & Last)

Birthday

Trek/Journey Youth Leader Information

Child Name (First & Last)

Birthdate

What grade is the student entering in Fall 2026? (Note: Trek is only for Jr. High students who have already completed at least one year of Truth & Training while in Elementary School)

6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

FAMILY MEDICAL RELEASE

The information provided below can help emergency medical personnel provide time sensitive care for your child. Cornerstone Church will keep a paper copy on hand for each child to accompany them in the event of a medical emergency. All information will be securely disposed of after the completion of AWANA year.

Please list any allergies, medical conditions, medication, or special considerations that should be known about this child.

Medical Insurance Company (if left blank this could interrupt medical treatment in case of emergency)

Insurance Policy Number

Physician name and phone number if important for emergency medical treatment

Medical Release: This consent form gives permission to seek medical attention as deemed necessary and releases the Church and its staff of any liability against personal losses of named child. In the event that he/she is injured and requires the attention of a medical provider, I consent to any reasonable medical treatment as deemed necessary by a licensed provider. In such an event where treatment is required, from a provider and/or hospital personnel designated by the Church, I agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.

Agree

ADDITIONAL INFORMATION

Emergency Contacts Names and Phone Numbers (other than listed above)

Does your child attend church regularly?

Yes, at Cornerstone Yes, at another church Not currently

If somewhere else, where?

Media Release: By attending Awana at Cornerstone Church, I am releasing permission of my child(s) photo or video to be used for promotional purposes. Please check the box if you agree.

Yes

PAYMENT SUBMISSION

The cost of Trek covers the cost of the book only. Your child will receive a T-Shirt appropriate to the club they serve along with the other leaders.

Cost of each Trek Student:

Youth Leader Shirt Size

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

AWANA 2026-2027 Youth Leader Registration

Description

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