2018-2019 AWANA Clubs Permission Slip
Faith Baptist Church | 2111 Kuser Road, Hamilton Square, NJ
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
Child's last name
Grade entering in the fall of 2018
Child's date of birth
Parents’ / Guardians’ name(s):
Street Address, City, State, Zip Code
Cell phone number
House phone number
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.
Specific food or medical allergies, chronic illness, or other conditions:
Insurance Company and Policy Number
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.
Please sign your name below to grant permission for your child to attend the AWANA Club at Faith Baptist Church.
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