Awana Registration

Child Name

First NameLast Name

Gender

Age

Grade

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

How will child be attending

Address of pick up if different from mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Allergies

Emergency Contact

Name & Phone Number

Would you be interested in helping in Awana this year?

Photo Release: I give permission for my child(ren) to appear in photo or video which may be taken during Awana to appear on media of Stillwell Bible Baptist Church or be used for publicity or display purposes. Note: no private information will be disclosed publicly

Consent to Medical Treatment:In the event my child becomes ill or injured, I give permission for a representative of Stillwell Bible Baptist Church to take whatever steps are reasonably necessary to render first aid to my child. I also consent to such medical treatment as may be reasonably necessary to render emergency first aid to my child. I also consent to such emergency medical treatment as may be reasonably necessary to insure the health and welfare of my child including but not limited to, x-rays, anesthetic, medical or surgical diagnosis and treatment, hospital care and administration of drugs or medicine under the care of a licensed physician and/or surgeon.

Security of your child(s) is important to us. The AWANA leadership has my permission to dismiss my child(s) to the following individual(s), if I am not able to pick up my child. If there is any pertinent information we need to know, pertaining to the pick up of your child(s), please state below.

Release of Liability:
I for myself, my minor child and for the child's other parent and/or guardian, hereby release, waive, discharge and covenant not to sue Stilwell Bible Baptist Church, and it's officers directors, employees, agents, volunteers, heirs, and assigns from all liability, loss, claims, demands, possible causes of action, court cost, attorney's fees and other expenses arising from any lawsuit that may otherwise occur from any loss, damage or injury to my child's person or property in any way resulting from or connected with my child's attendance at Awana, including, without limitation, the failure of anyone to enforce rules and regulations, failure to make inspections, or negligence of other persons.

Signature