Awana Registration/Medical Release Form 2013-2014

To enroll your child in the Awana Club at Spinning Road Baptist Church, please complete, & submit this form.
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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 treatment; 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

    After you submit this form:

    Please see one of the Awana Co-Commanders to sign a paper copy for our records.