2025 AWANA Club Registration and Permission Form
Welcome to AWANA at Walnut Park Baptist Church! Use this form to register your kids for our weekly AWANA program on Wednesdays at 6:30 PM. For more info, see https://www.walnutparkbaptistchurch.com/awana
Parent/Guardian Info
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Is this a landline or cell phone:
Land Line
Cell Phone
Email
*
example@example.com
Family Church
Church where you attend regularly, if you have a church home
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Emergency Contact Info
Name (other than parents)
*
First Name
Last Name
Phone Number of person listed above
*
-
Area Code
Phone Number
Primary Doctor
Primary Doctor's Phone Number
-
Area Code
Phone Number
Name of Insurance Company
Insurance Company Phone Number
-
Area Code
Phone Number
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Child 1 Info
How many children will you be registering for AWANA?
1
2
3
4
5
Clubs: *Cubbies: 3-4 yr. olds *Sparks: K-2nd grades *T&T: 3rd-6th grades
Child 1 Name
First Name
Last Name
Child 1 Gender
Male
Female
Child 1 Birthdate
-
Month
-
Day
Year
Date
Child 1 Club
Cubbies (3-4 year olds)
Sparks (K-2nd grades)
T&T (3rd-6th grades)
Child 1 Grade
K4
3rd
K5
4th
1st
5th
2nd
6th
Child 1 School
Please list any information such as food allergies, medical conditions, or other special needs.
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Child 2 Info
Child 2 Name
First Name
Last Name
Child 2 Gender
Male
Female
Child 2 Birthdate
-
Month
-
Day
Year
Date
Child 2 Club
Cubbies (3-4 year olds)
Sparks (K-2nd grades)
T&T (3rd-6th grades)
Child 2 Grade
K4
3rd
K5
4th
1st
5th
2nd
6th
Child 2 School
Please list any information such as food allergies, medical conditions, or other special needs.
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Child 3 Info
Child 3 Name
First Name
Last Name
Child 3 Gender
Male
Female
Child 3 Birthdate
-
Month
-
Day
Year
Date
Child 3 Club
Cubbies (3-4 year olds)
Sparks (K-2nd grades)
T&T (3rd-6th grades)
Child 3 Grade
K4
3rd
K5
4th
1st
5th
2nd
6th
Child 3 School
Please list any information such as food allergies, medical conditions, or other special needs.
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Child 4 Info
Child 4 Name
First Name
Last Name
Child 4 Gender
Male
Female
Child 4 Birthdate
-
Month
-
Day
Year
Date
Child 4 Club
Cubbies (3-4 year olds)
Sparks (K-2nd grades)
T&T (3rd-6th grades)
Child 4 Grade
K4
3rd
K5
4th
1st
5th
2nd
6th
Child 4 School
Please list any information such as food allergies, medical conditions, or other special needs.
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Child 5 Info
Child 5 Name
First Name
Last Name
Child 5 Gender
Male
Female
Child 5 Birthdate
-
Month
-
Day
Year
Date
Child 5 Club
Cubbies (3-4 year olds)
Sparks (K-2nd grades)
T&T (3rd-6th grades)
Child 5 Grade
K4
3rd
K5
4th
1st
5th
2nd
6th
Child 5 School
Please list any information such as food allergies, medical conditions, or other special needs.
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Terms and Conditions
I understand that
my child/children 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, AWANA Clubs International, Walnut Park Baptist Church and any persons involved in the AWANA club ministry.
In the event of an emergency that requires medical treatment for the above-named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached,
I give my permission to the Walnut Park Baptist Church AWANA volunteers to secure the services of a licensed physician to provide the necessary care (including x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital) to be rendered to the minor on the advice of and under the supervision of a tending physician for my child's well-being
. I assume responsibility for all costs connected to any accident or treatment of my child. This form releases Walnut Park Baptist Church of any responsibility for any costs connected with any treatments necessary including those listed above, and shall remain in effect until modified by the child's parent/legal guardian.
I grant permission for a photo of my child/children to appear among other general club photos
or on an AWANA website/social media as long as there is no identifying information shown.
I grant permission for my child/children to travel to/from AWANA club events with an adult leader
. Any such event will be clearly communicated with me beforehand.
Signature
Please list any individuals who may not provide transportation to/from club or have access to your child at AWANA
Submit
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