AWANA 2018 Registration

Please fill out one registration for EACH child that will be attending AWANA. We apologize for any inconvenience.

Child/Clubber Information

Name of Child

Gender

Male Female

Child's Primary Address

Allergies

What is your child's birthday?

Are there any special or unique needs your child has that FBC Fairlea should be aware of?

Parent and Legal Guardian Information

Who is the LEGAL guardian of your child? (Check all that apply)

Mother Father Grandparent Other

Are you (the individual filling out this form) the legal guardian of the child/children attending AWANA at FBC Fairlea?

Yes No

Mother's First Name

Mother's Last Name

Mother's Email

This address will receive a confirmation email

Mother's Mobile Phone

Mother's Address

Mailing address if different

Father's First Name

Father's Last Name

Father's Email

Father's Mobile Phone

Father's Address (If different then Mother's)

Mailing address if different

Legal Guardian First Name (If different then parents)

Legal Guardian Last Name (If different then parents)

Legal Guardian Address (If different then parents)

Legal Guardian Phone (If different then parents)

Legal Guardian Email (If different then parents)

Do you have a church you attend on a weekly basis?

Yes No

How did you hear about our AWANA Program (check all that apply)?

Newspaper Invitation From a Friend Electric Sign Sign in Front of the Church Church Bulletin Postcard School Flyer

Safety Information

Are there any people who are not legally allowed to pick your child up from awana? Are there any custody or family situations we need to be aware of?

List at least one person (first and last name) who may be contacted to pick up the child if parents cannot be reached in case of emergency

Emergency Contact Mobile Phone

Terms Conditions and Consent

I understand that my child 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, First Baptist Church Fairlea and any persons involved in the AWANA Club ministry.

Yes No

In the event of an emergency that requires medical treatment for the child whose information is listed on this form, 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 or emergency medical personnel 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.

Yes No

Execution of this document shall operate as an authorization for AWANA leaders to release any medical information to physicians, hospitals, or medical attendants as authorized above, which they require.

Yes No

As the legal guardian I have read and agree to the Terms and Conditions stated above: (please type name below to sign)

Select Date

AWANA 2018 Registration

Description

Please Fix the Following