AWANA REGISTRATION
Awana - $15 Registration Fee Collected at Awana
Parent/Guardian name *
Your answer
Home Address *
Your answer
Primary Phone Number *
Your answer
Other Phone
Your answer
Work Phone
Your answer
Family Church *
Your answer
Email Address *
Your answer
Persons (other than Parents) authorized to pick up children *
Your answer
Emergency Contact (other than Parents) *
Your answer
Emergency Contact Phone *
Your answer
Child Information
Name *
Your answer
Nickname
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender *
Grade *
Your answer
School *
Your answer
Medical Information (allergies, medicines, special needs) *
Your answer
Terms and Conditions
1) I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability Family Bible Church and any persons involved in the Awana Club ministry.

2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child’s well being. I assume responsibility for all cost connected to any accident or treatment of my child.

3) I give permission for photo(s) of my child to appear among other general club photos as long as no identifying information is shown.

I have read and agree to the Terms and Conditions above *
If no, please provide us with your reasons for our records:
Your answer
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