AWANA and Youth Registration Form

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Please fill out a form for each child that will be participating in AWANA or Youth Group at Bethany.

Child's Name *

Age *

Grade *

Birthdate *

YYYY

Address *

Parent/Guardian Name *

Emergency Phone Number *

Email Address *

Allergies or Other Health Concern

Photo Release Form for Minor Children

I hereby authorize Bethany Baptist Church of Chicago (Bethany) to publish the photographs and videos taken of me and/or the above minor children, and our names, for use in Bethany's printed publications, website, social media and training purposes. I release Bethany from any expectation of confidentiality for the above minor children and myself and attest that I am the parent or legal guardian of the children listed and that I have the authority to authorize Bethany to use their photographs, videos and names. I acknowledge that since participation in publication, website or social media content produced by Bethany is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication, website, or social media content produced by Bethany confers no rights of ownership whatsoever. I release Bethany, its contractors, and its employees and volunteers from liability for any claims by me or any third party in connection with my participation or the participation of the above minor children *

Yes

Required

As parent/legal guardian of the child named above, I give my permission for him/her to attend the Bethany Baptist Church AWANA Club and/or Youth Group. I understand and acknowledge that participation in the activities involves inherent risks. I agree to indemnify Bethany Baptist Church for any costs or expenses arising out of my child's participation in activities including the cost of any medical care given to my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activity. Bethany Baptist Church takes no other responsibilities outside of meeting expectation of provision of initial first aid. *

Yes I give my permission and agree

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