Awana Registration Form

KILGORE BIBLE CHURCH

Awana Activities Consent to Participate and Release of Liability
#1 Child's Name*

Full NameBirthdayGrade (going into for the yr 24/25)
Gender*
#2 Child's Name

Full NameBirthdayGrade (going into for the yr 24/25)
Gender
#3 Child's Name

Full NameBirthdayGrade (going into for the yr 24/25)
Gender
#4 Child's Name

Full NameBirthdayGrade (going into for the yr 24/25)
Gender
#5 Child's Name

Full NameBirthdayGrade (going into for the yr 24/25)
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mom/Guardian Name*
Dad/Guardian Name
Mom/Guardian Phone Number*
Format: (000) 000-0000.
Dad/Guardian Phone Number
Format: (000) 000-0000.
Mom/Guardian Email*
example@example.com
Dad/Guardian Email
example@example.com
Medical Insurance *
Policy #/ Member ID*
Emergency Contact Name*
Emergency Contact Number*
I give my consent as legal guardian for my CHILD/CHILDREN (circle one) listed above to participate in Kilgore Bible Church’s Awana activities, both on and off church premises, and including any transportation provided, for the Awana year 2024-2025. I will not hold Kilgore Bible Church and/or any of its Awana leaders responsible for any injuries/illnesses my child may incur while observing or participating in any church-approved Awana activities. I also give my consent for my CHILD/CHILDREN to receive any medical treatment that may be deemed advisable in the event of injury, accident, and/or illness. If I cannot be reached, I authorize Kilgore Bible Church Awana leaders to make emergency medical decisions for my child. Media Release: I understand that my CHILD/CHILDREN may be photographed and I assign all rights to the photographs/videos to Kilgore Bible Church. I consent to the editing and publication of these photographs/videos on its website and in local print and promotions.
Signature

Clear
*Cash and checks are accepted. Checks can be made to KBC, with a note it’s for Awana. Please speak to Philip at the front desk about books, vests, and amount due as it varies each year depending on vests, and what book children need. Payment due at the time of registration, if registering online please plan to pay on the first night.
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KILGORE BIBLE CHURCH