Friday AWANA Program

Since AWANA is a ministry aimed to partner with parents in raising their kids with a lasting faith in Christ, parents are required to either serve in the ministry (for Christian parents) or be equipped by attending CCIC-SJ’s fellowship unless specific reason is given.

Date: 9/8/2017-6/1/2018 (except several holidays – to be informed on AWANA Parent Night)
Time: 7:30pm-9:30pm
Check In: Check in at 1st floor before 7:30pm and stations open at 7:15pm.
Pick Up: Please be prompt to pick up your child(ren) by 9:25pm at 1st floor when the program ends unless you sign up your child(ren) for self-dismiss.  Parents are responsible for their child’s safety after 9:25pm.

All children must be checked in and picked up by an authorized adult at the above designated areas.

Parent/Guardian's Information 父母/代理监护人资料

Father's Name 父亲姓名:*
Father's Chinese Name (父亲中文名-以中文输入):
Is Father A Christian? 父亲是否为基督徒?*
Mother's Name 母亲姓名:*
Mother's Chinese Name (母亲中文名 - 以中文输入):
Is Mother A Christian? 母亲是否为基督徒?*
Parent's Correspondence Email 父母/代理监护人联络电邮:*
Parent/Guardian's Cell Phone 父母/代理监护人手机:*
Address 地址 (SKIP if you signed up for 2017 LEGO Camps 若您注册了2017 LEGO Camps,地址可不填:
Are You Attending church? 是否上教会? *
In case of an EMERGENCY and the above person(s) cannot be contacted, please notify: 紧急联络人(若无法联络以上父母/代理监护人):*
Cell Phone 紧急联络人手机:*
Relationship with Child 选择与小孩的关系:*
Select Church Program 选择聚会:*

Child's Information 小孩资料

If you signed up for 2017 Bricks4God LEGO Summer Camps, you can SKIP these fields: 1) Medical Coverage 2) Insurance ID
若您注册了2017 Bricks4God LEGO Summer Camps, 您可不填写1)医疗保险 2)保险卡号。

PLEASE Select Age/Grade by FALL 2017 (NOT Current Age/Grade) 敬请选择秋季2017年龄/班级 (不是现今年龄/班级).

1st Child's Name 第1个孩子姓名:
Gender for 1st child 性别:
Date of Birth for 1st child (enter 3/10/2000 for March 10, 2000) 生日日期:
Select Age/Grade by FALL 2017 (NOT Current Grade) 年龄/班级(秋季2017):
Allergy for 1st child 过敏:
Medical Coverage for 1st child 医疗保险:
Insurance ID for 1st child 保险卡号:
Select Uniform Size (refer size below) for 1st child (if uniform is required) 制服尺寸:


2nd Child's Name:
2nd Child's Gender:
2nd Child's DOB:
2nd Child's Age/Grd by FALL 2017:
2nd Child's Allergy:
2nd Child's Medical:
2nd Child's Insurance ID:
2nd Child's Uniform:


3rd Child's Name:
3rd Child's Gender:
3rd Child's DOB:
3rd Child's Age/Grd by FALL 2017:
3rd Child's Allergy:
3rd Child's Medical:
3rd Child's Insurance ID:
3rd Child's Uniform:

Self-Dismiss Authorization 授权小孩自行离开聚会

You can only authorize CURRENT 1st-5th graders to self-dismiss from our programs.

Would you authorize your child(ren) to self-dismiss? 是否授权小孩自己离开聚会?:

Please fill out our Self-Dismiss Authorization Form if you would like to have your child(ren) self-dismiss from our program when it ends.


To Serve in AWANA Ministry 在AWANA事工服事

To sustain the ministry, we strongly encourage Christian parents to join us. If you would like to serve with us, please select the area to serve. We'll follow up with you later. 我们强力鼓励基督徒父母参与我们支撑此事工。若您想与我们一起服事,请选择以下事奉岗位。我们将与您联络。

I'd like to serve in 我想在以下方面事奉:

Authorization, Medical and Media Release 授权


I agree (by checking this box, I recognize that this is equivalent to my legal signature) to give my child permission to participate in the AWANA program at Chinese Church in Christ (CCIC) San Jose on Fridays from Sept 8th, 2017 to June 1st, 2017 (except AWANA holidays - to be informed) from 7:30pm to 9:30pm. I understand that I should attend one of CCIC's fellowships/programs or serve in AWANA (only Christian can be book leader) while my child(ren) is/are attending the AWANA Program.


I agree that I hereby hold harmless and waive any and all claims against CCIC, its staff, and leaders for any accident, bodily or personal injury, damage to or loss or theft of any property, illness, or death of any person, including without limitation demands, liabilities, damages, judgments, losses, costs, expenses and/or penalties, including attorneys’ and consultants’ fee and disbursements, which arise out of joining the AWANA Program sponsored by CCIC.

I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOWN THE CONTENTS THEREOF AND IS SIGNING THIS RELEASE AS AN ACT OF MY OWN FREE WILL.  This is a legally binding agreement, which I have read and understand.

I give my permission for my child to be photographed, videotaped, and/or interviewed by representatives from CCIC for the purpose of publications which include church bulletins, promotion, online media, website, and church presentations. I fully relinquish my right or interest in any film, tape, or photograph which may be used for any legitimate purpose.

I also hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed medical personnel on the staff of any licensed hospital. This authorization is given in advance of any specific diagnosis, treatment or hospital care required, but is given to provide authority and power to render care which is deemed advisable in the best judgment of the physician.

I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOWN THE CONTENTS THEREOF AND IS SIGNING THIS RELEASE AS AN ACT OF MY OWN FREE WILL. This is a legally binding agreement, which I have read and understand.

Recaptcha Word Verification: