AWANA 2019 Registration

A separate form must be filled out for each child and signed by a legal guardian of this child.

Child's Information

Child's name

Gender

Male Female

What is your child's birthday? (mm-dd-yyyy)

Child's Primary Address:

Health and Safety Needs

Does your child have any allergies?

If yes, please explain.

Are there any special or unique needs of your child that AWANA staff should be aware of?

If yes, please explain.

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

If yes, please explain.

First and Last Name of Emergency Contact Person (to be contacted to pick up your child if a legal guardian cannot be reached in case of an emergency)

Phone Number:

Guardian Information:

If mother and father are both guardians and have the same address as the child, please list the names and phone numbers of each:

Mother's First and Last Name

Phone

This address will receive a confirmation email

Father's First and Last Name

Father's Phone Number

Father's Email

First and Last Name of Guardian other than mother or father:

Relationship to child:

Phone number:

Email address:

General Information

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 Sign in Front of the Church Church Bulletin Postcard School Flyer

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

In order for my child to participate in AWANA this year, I agree that he/she will follow all health protocols and mandates established by the leadership of the AWANA program at First Baptist Church Fairlea. These regulations may be put into place to help control the spread of COVID-19 or to mitigate other health issues. I understand that failure to follow these guidelines will necessitate that my child withdraw from the program. Also, I realize that these guidelines cannot guarantee that my child will not contract COVID-19 at AWANA and therefore agree to hold First Baptist Church harmless from any claims on behalf of me or my child if he/she contracts COVID-19. (Parent or guardian, please type your name in the box to verify you have read this section.)

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

Date

AWANA 2019 Registration

Description

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