FBC AWANA Clubs Permission Slip
Faith Baptist Church | 2111 Kuser Road, Hamilton Square, NJ
* Required
By filling out this form, you are granting the following:
I give my permission for my child, to attend all AWANA activities during the club year.
It is understood that the parents will not in any way hold Faith Baptist Church responsible or liable for any accident caused by your child’s disobedience. I also give permission for emergency treatment by a qualified physician, in case of an accident. I have included my health insurance number. As a parent or guardian, I do herewith authorize the treatment by a qualified medical doctor of the following minor in the event of a medical emergency which, in the opinion or the attending physician, may endanger his or her life, causing disfigurement, physical impairment, or undo discomfort if delayed. This authority is only granted after reasonable effort has been make to reach me.
Child's first name
*
Your answer
Child's last name
*
Your answer
Grade entering in the fall
*
Choose
Pre-K
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Child's date of birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Parents’ / Guardians’ name(s):
*
Your answer
Address
*
Street Address, City, State, Zip Code
Your answer
Email
Your answer
Cell phone number
*
Your answer
House phone number
Your answer
Emergency Contact Information
*
In case of an emergency, please contact (a responsible adult relative / friend, other than spouse) . Please provide a name AND phone number to contact.
Your answer
Specific food or medical allergies, chronic illness, or other conditions (else type “None”):
*
Your answer
Insurance Information
Insurance Company and Policy Number
Your answer
Please check all that apply
My child’s picture, without his/her name, can be put on the AWANA website.
Do not put my child’s picture on the AWANA website.
I have access to the internet and can view the AWANA weekly newsletter.
I do not have internet access and would like a paper copy of the AWANA weekly newsletter.
Digital Signature
*
Please sign your name below to grant permission for your child to attend the AWANA Club at Faith Baptist Church.
Your answer
Submit
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
