AWANA PARENTAL CONSENT FORM

AWANA PARENTAL CONSENT FORM
Clubbers name
Gender
Grade
Age
DOB
Address
City
State
Zip
Guardians
Parent or Guardians Email
example@example.com
Home phone
Cell phone #(s)
Do you currently attend church? YES or NO If yes, where?
If yes where
EMERGENCY CONTACT INFORMATION if above numbers cannot be reached
Please list any allergies or special medical information we may need to know
Who will be allowed to pick up this clubber?
I hereby give permission for my child _______________ to participate in activities sponsored by Judson Baptist Church AWANA clubs from August 2025 through April 2026.
(Please answer these questions with a Yes or No) Judson Baptist Church has permission to photograph or video my child
Judson Baptist Church has permission to photograph or video my child
JBC may use my childs photograph or video in printed andor digital media
SIGNATURE

Clear
DATE

MonthDayYear
Date
PLEASE PRINT
Should be Empty: