Awana Student Registration/Medical release form 2018 - 2019

(For Club meetings and all supervised Awana outings)

To enroll your child in the Awana Club at Spinning Road Baptist Church, please complete this form. Awana registration personnel will print out the form and have you sign it later.

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    Medical RELEASE Authorization

    I hereby give permission to the physician selected by SRBC leaders to order X-rays, routine tests and treatments, to release any records necessary for insurance purposes and to provide or arrange necessary related transportation for my child. I am aware that every precaution will be taken for the safety of my child. In the event of an emergency I will be contacted immediately. If I or my emergency contact person can not be reached, I hereby authorize the physician selected by SRBC leaders to secure and administer treatment which, in the opinion of the attending physician may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed, including hospitalization, ambulance transport and paramedics for the above named child. I hereby agree to fully pay all costs of medical or dental care connected with this treatment, and/or incurred by SRBC or their agent. I hereby release Spinning Road Baptist Church, Pastor, volunteers, agents, and vehicle driver of any vehicle driven (if transportation is part of an event) from liability. This agreement does not apply to claims for intentional misconduct or gross negligence.

    Photo/Video Release

    Photos/Videos taken during the Club year are used to promote our Awana program on the Church website. If you would prefer not to have individual pictures of your child included please indicate below. We cannot guarantee that your child will not be included in group photos/video of Awana events.
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    Thank you for beginning the registration process by filling out this electronic form. Awana registration personnel will print out the form and have you sign it at the check-in table the first night you attend club. Press the submit button below to complete the sign-up process.

    Parent/Guardian Signature

    (Awana registration personnel will print out the form and have you sign it later.)

    Date of signature

    (when you sign the form, please put the date here)