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AWANA T&T - First Night Check In
AWANA T&T at Walnut Park is for children in 3rd through 6th grade. Please enter all of your information for this initial check in. Thank you!
Email address *
Today's Date: *
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Child's First Name: *
Your answer
Child's Last Name: *
Your answer
Child's Birthday: *
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Parent's First Name: *
Your answer
Parent's Last Name: *
Your answer
Phone Number: *
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Street Address: *
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Does your child attend church/Sunday School anywhere? If yes, where?
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Phone Number: *
Your answer
What adults do you authorize to pick up your child from AWANA this year at 8:00 p.m.? (Please list their name and their phone number if it is not already listed in this form.) *
Your answer
Family Physician:
Your answer
Date of Last Tetanus Shot:
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Medications child is currently taking:
Your answer
Medical Conditions:
Your answer
Allergies:
Your answer
Other contact(s) in case of emergency:
Your answer
Name of Insurance Company:
Your answer
Policy #
Your answer
This form releases Walnut Park Baptist church of any responsibility for any costs connected with any treatments listed above, and shall remain in effect until modified by the child's parent. Do you authorize the AWANA staff at Walnut Park to seek medical attention for your child in the event that the emergency contact cannot be reached? (Checking yes in this box is the digital equivalent of your signature.) *
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