AWANA Clubber Registration
Clubber Name
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Parent/Guardian Name(s)
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Street Address
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City
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State
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Zip
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Home Phone Number
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Cell Phone Number
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Emergency Contact
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Email Address
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Persons other than parents authorized to pick up clubbers
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Clubbers birth date
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Gender
Grade
Select an Option for Needed Materials
Which Bible version do you prefer for your clubbers handbook?
List any allergies/medications/special needs.
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Please read the following terms and conditions:1) I understand that my child(ren) may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of physical injury. I fully accept the risk and hold harmless form any legal liability Fellowship Baptist Church and any persons involved in the AWANA ministry. 2) In the event of an emergency that requires medical treatment for the above named child(ren), I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give permission to the AWANA volunteers to secure the services of a licensed physician to provide care necessary for my child(ren)’s well-being. I assume responsibility for all costs connected to any accident or treatment of my child. 3) I grant permission for a photo of my child to appear among general club photos to be used only by FBC as long as there is no identifying information shown.
Please type your name to serve as your signature. By signing below, you agree to the terms and conditions stated above.
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