AWANA CLUBS REGISTRATION

CHILDS NAME

PARENT(S) OR GUARDIAN'S NAME

ADDRESS

Phone

This address will receive a confirmation email

Gender

Male Female

Birthdate

Grade (attending this year)

PreK 3 yrs old Before Sept.1st PreK 4 yrs old Before Sept.1st Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade

Please select the box that applies to your child

Pre K - Cubbies Kindergarten thru 2nd grade - Sparks 3rd grade thru 6th grade T&T (Truth and Training)

How often do you attend church services?

Where do you regularly attend Church?

What age would you like work with?

Emergency Contact Person

Name

Phone

These adults may pick up my child:

Liability & Health Release:

Please sign the following statement if you desire to have your child participate in Awana.

Every activity sponsored by the church is carefully planned and adequately supervised by mature adults. However, even with the best of planning precaution, unforeseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks and hazards inherent in church-related social activities. They also agree not to hold this church or its employees or volunteer assistants liable for damages, losses, or injuries to the person or property undersigned.

In case of emergency, I understand that every effort will be made to contact me. However, if I cannot be reached, I hereby give permission to the physician selected by Silverton 1st Baptist to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child. The parents or guardians understand that they are signing for the minor listed on this form and the signature is for a liability and health release.

Parent or Guardian please sign & date your agreement and understanding of the above statement:

Is this child currently taking any medication(s)? Please list. (information needed for emergencies only)

Does the child have any dietary restrictions?

Does your child need help with reading?

Yes No

In an effort to provide consistency for your child, we would like to know if you anticipate that your child will require one-on-one help/attention from a leader?

Yes No

If so, please explain.

Please list any health conditions and/or food allergies including food, insect stings, and medications.drugs.

Photo / Video Release:

I hereby approve and consent to the use of my child’s photo image during Awana at Silverton First Baptist Church. Pictures will be taken only by approved Children’s Ministries Staff. No names of children will be posted on-line. Please type name for approval:

AWANA CLUBS REGISTRATION

Description

Please Fix the Following