First Baptist Bellville Awana Registration

First Baptist Bellville Awana Registration

For 3 Years - 5th Grade
Please complete all applicable sections below so we can register your child safely and accurately.
Parent Information
Parent or Guardian Name
Spouse or Second Parent Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Child Information
Child's Name (1)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Grade
Gender
T-Shirt Size
Allergies
Medical Conditions
Special Needs or Additional Information
Child's Name (2)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Grade
Gender
T-Shirt Size
Allergies
Medical Conditions
Special Needs or Additional Information
Child's Name (3)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Grade
Gender
T-Shirt Size
Allergies
Medical Conditions
Special Needs or Additional Information
Emergency Information
Emergency Contact Name
Relationship to Child/Children
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pickup Authorization
Please list the names of individuals authorized to pick up your child from Awana.
Photo/Media Release and Acknowledgments
As a parent or guardian, I give permission for my child to be photographed and recorded for event media.
I agree to the pickup authorization above.
I certify that the information provided on this form is accurate. I agree to notify First Baptist Bellville of any changes to my child's medical information, emergency contacts, or pickup authorization.
I give permission for my child to participate in the Awana ministry at First Baptist Church Bellville, TX. I understand that reasonable plans have been made to ensure the safety and welfare of all participants. I also understand that volunteer adults and staff will be chaperoning activities and will take reasonable actions as they deem necessary to protect the best interests of all participants. In signing this document, my child agrees to conduct himself/herself in a safe and orderly manner and will cooperate with decisions made by the adult volunteers. I have read and understood the conditions described above and give permission for my child to participate in this group activity. I hereby authorize a representative of First Baptist Church of Bellville to consent to and authorize emergency medical treatment, surgery or dental care to be given to my son/daughter as considered advisable or necessary in the judgment of an emergency medical professional or attending physician. This authority is granted only after a reasonable attempt has been made to reach me by all phone numbers provided.
Parent or Guardian Signature
Date

MonthDayYear
Date
Order Form

Awana club registration is $25 and includes your child's t-shirt, books needed throughout the year, and programming costs. Bags and vests can be purchased for an additional $25.
Does your Child need a new book?
If so, what was the last handbook your child completed?

My Products

Awana Registration (includes t-shirt and book) $25.00

For reach child attending Awana

Quantity

Cubbies Bag and Vest $25.00

Quantity

Sparks Bag and Vest $25.00

Quantity

T&T Backpack$25.00

Quantity

Total $0.00

Credit Card

Should be Empty:

First Baptist Bellville Awana Registration

Parent Information

Child Information

Emergency Information

Photo/Media Release and Acknowledgments

Order Form

My Products

Credit Card