AWANA 2023-2024 Registration Form

Child's Name

First NameLast Name

Child's Age

Child's Grade for the 2024-2025 School Year

Child's Date of Birth

Date

Child's Gender

MaleFemale

Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Legal Guardian's Name

First NameLast Name

Parent/Legal Guardian's Phone Number

Please enter a valid phone number.

Parent/Legal Guardian's Email Address

example@example.com

Emergency Contact (if Parent/Legal Guardian already listed can not be reached)

First NameLast Name

Emergency Contact's Phone Number

Please enter a valid phone number.

Permission to take photos of your child during AWANA activities

YesNo

Allergies (this is very important as we serve snacks and drinks each week!) - if none, please put N/A, if yes, please list below

Liberty Missionary Baptist Church and its Volunteers are collectively designated by the abbreviation “LMBC” throughout this entire form.

I hereby give permission for my child to attend and participate in activities, including, but not limited to, indoor/outdoor recreational activities and supervised water activities sponsored by LMBC (“LMBC Activities).

I hereby authorize LMBC to call for emergency transport to an emergency facility for medical treatment in the event of an emergency in which neither the parent/legal guardian nor the Emergency Contact can be reached.

The undersigned parent/legal guardian shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned agrees to and shall assume all transportation costs.

I, in both my personal capacity and as parent/legal guardian of this child, hereby release, forever discharge and agree to hold harmless LMBC its directors, employees, volunteers, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned adult and the child/participant that occur while said child is participating in LMBC Activities.

Furthermore, I and on behalf of my child, if under the age of eighteen (18) years, hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participating in LMBC Activities.

Further authorization and permission is hereby given to LMBC to furnish necessary transportation (if applicable) and food (I have been given the opportunity to notate any food allergies) for this participant.

The undersigned further hereby agrees to hold harmless and indemnify LMBC, its directors, volunteers, employees, and agents for any liability sustained by LMBC as the result of the negligent, willful, or intentional acts of said child, including expenses incurred attendant thereto.

The medical consent and liability waiver provisions hereof shall remain in full force throughout the 2024-2025 activities year and in effect until written notice of revocation or withdrawal is received by LMBC at its office at 5944 Franklin Branch Rd McKinney, TX 75071. It is the responsibility of the parent/legal guardian to notify LMBC of any changes in medical condition, guardianship, address or telephone change in writing to the address provided in this paragraph.

I have read and agree to the above medical and liability waiver and understand if I do not agree to it, my child will not be allowed to participate in LMBC's AWANA Activities and Program for the 2023-2024 year.

Signature of Parent or Legal Guardian

AWANA 2024-2025