AWANA Registration

Parent/Legal Guardian Information

Name of Parent/Guardian

Relationship to Child

Address

City

State

Zip

Home Phone

Cell Phone

Do you attend church?

Yes No

Emergency Contact Information (other than parent/guardian)

Name of Emergency Contact #1

Emergency Contact #1 Phone

Emergency Contact #1 Relationship to Child

Name of Emergency Contact #2

Emergency Contact #2 Phone

Emergency Contact #2 Relationship to Child

Clubber Information

Name of Child #1

Chlid #1 Gender

Child #1 Age

Child #1 Grade

Child #1 Birthdate

Child #1 Club

Puggles (Ages older 2s)

Cubbies (Ages 3 – PreK)

Sparks (K – 2nd Grade)

T & T (3rd – 4th Grade)

T & T (5th – 7th Grade)

Child #1 Shirt Size

Child #1 Allergies (state NONE if none) or Special Information (Medications, Activity Restrictions, etc)

Name of Child #2

Chlid #2 Gender

Child #2 Age

Child #2 Grade

Child #2 Birthdate

Child #2 Club

Puggles (Ages older 2s)

Cubbies (Ages 3 – PreK)

Sparks (K – 2nd Grade)

T & T (3rd – 4th Grade)

T & T (5th – 7th Grade)

Child #2 Shirt Size

Child #2 Allergies (state NONE if none) or Special Information (Medications, Activity Restrictions, etc)

Name of Child #3

Chlid #3 Gender

Child #3 Age

Child #3 Grade

Child #3 Birthdate

Child #3 Shirt Size

Child #3 Club

Puggles (Ages older 2s)

Cubbies (Ages 3 – PreK)

Sparks (K – 2nd Grade)

T & T (3rd – 4th Grade)

T & T (5th – 7th Grade)

Child #3 Allergies (state NONE if none) or Special Information (Medications, Activity Restrictions, etc)

Name of Child #4

Chlid #4 Gender

Child #4 Age

Child #4 Grade

Child #4 Birthdate

Child #4 Shirt Size

Child #4 Club

Puggles (Ages older 2s)

Cubbies (Ages 3 – PreK)

Sparks (K – 2nd Grade)

T & T (3rd – 4th Grade)

T & T (5th – 7th Grade)

Child #4 Allergies (state NONE if none) or Special Information (Medications, Activity Restrictions, etc)

Consent

I consent to and approve my child/children's taking part in any and all activities conducted by Woolmarket Baptist Church AWANA Clubs. 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 consent to the treatment of any minor injuries of my child/children, and release, hold harmless and indemnify AWANA and the Church and their officers, directors, agents, employees and volunteers from any and all liability, claims and costs arising from or growing out of such treatment. 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.

I understand that any off-property Awana excursions will be communicated with me beforehand and I will be required to sign a separate medical release form in order for my child to participate in those excursions.

I give permission for photo(s) of my child/children to appear among other general club photos in any and all media as long as there is no identifying information. I hereby waive any causes of action I may have because of the use of my child's photograph.

By selecting the "SUBMIT" button below, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your
manual signature on this agreement.

AWANA Registration

Parent/Legal Guardian Information

Emergency Contact Information (other than parent/guardian)

Clubber Information

Consent

A Place of Worship and Encouragement.

Service Times

Woolmarket Baptist Church