AWANA Registration Form

*If filling this form out on your smart phone we recommend rotating your phone to the landscape position.

Parent/Legal Guardian

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email

example@example.com

Primary Phone Number

Area Code Phone Number

Alternative Phone Number

Area Code Phone Number

Emergency Contact

First Name Last Name

Phone Number

Area Code Phone Number

Children Information

	Name	D.O.B.	Grade	Allergies
Child #1
Child #2
Child #3
Child #4
Child #5

Where do you regularly attend church?

How did you hear about our club?

I understand that my child may incur risk of injury while participating in physical activities, such as Game time. I agree to hold harmless Grace Baptist Church, AWANA Club directors or volunteers from any legal liability. I also hereby give my permission for any necessary medical attention to be administered to my child in the event of an accident, injury, illness, etc., until such time as I may be notified. I assume responsibility for payment for any such required treatment.

Signature

Clear

I understand that my child may be photographed or filmed during AWANA activities. I grant permission for my child’s images to be used only by GBC AWANA for the promotion of the club in print and/or online.

Signature

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Dear Parent / AWANA Participant(s):

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.

By participating in programs, services, and activities of Grace Baptist Church, you agree to the following:

On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Grace Baptist Church, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

Signature

Clear