Abbe Road Baptist Church AWANA Registration 2021-2022
Activity Permission, Release & Emergency Medical Treatment Form
Please complete for ALL minors (age 17 and under)
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Email *
Child's Full Name *
Child's Gender *
Child's Birthdate *
MM
/
DD
/
YYYY
Grade level *
ALLERGIES & MEDICATIONS: Does your child have any food allergies or dietary restrictions? *
SPECIAL NEEDS: *
Sensory/Behavior/Attention Issues:
Lives with (Parent/Guardian NAMES) *
Phone number where YOU can be reached while your child is at ARBC: *
Home Address *
Emergency Contact Full Name *
Emergency Contact Phone number *
Who is authorized to pick up the child? Include phone number if not listed above. *
A copy of your responses will be emailed to the address you provided.
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