AWANA Registration FormAWANA Registration 2016-17 Parent / Guardian Name:Address:City:State:Zip:Phone #:In addition, please include an emergency number (other than parents).E-Mail:Child's First & Last Name:Please include Nickname, Birth Date, Gender, Grade, & School.Special medical needs that we should be aware of:Persons (other than parents) authorized to pick up the children:Book & Uniform Yes, my child needs a book Yes, my child needs a uniform Yes, my child needs a book and uniform1) 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, Aboite Baptist 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 costs connected to any accident or treatment of my child.3) I grant permission for a photo of my child to appear in an unpublished club directory to be used by AWANA leaders only. I also give permission for photo(s) of my child to appear among other general club photos as long as there is no identifying information shown.I have read and agree to the Terms & Conditions stated above.Signature & Date:
