Cubbies Registration 2026

Cubbies Registration 2026 - 2027
3 Years (Potty Trained) - Pre K
Child's Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Name

First NameLast Name
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent's Name

First NameLast Name
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please place a "check" ✓ in the box by your preferred method of contact.
Method of Contact
Phone (Home)
Please enter a valid phone number.Format: (000) 000-0000.
Parents E-mail Address
example@example.com
Church Attending
Special Information (allergies, learning challenges, other needs)
Names of other authorized adults for Child Pick-up
Would you be willing to assist our club?
If so, how?
We take pictures throughout the year to promote our club. May we use photographs of your child?
Would you like to learn about other ministries of Kentuck Baptist Church?
PLEASE BE SURE TO COMPLETE THE MEDICAL RELEASE FORM ON THE NEXT PAGE!
OFFICE USE ONLY
Registration (All inclusive) - $50
T-Shirt Size
Payment Received - Cash
Check#

PERMISSION AND MEDICAL RELEASE FORM
THIS FORM MUST BE FILLED IN COMPLETELY AND SIGNED BEFORE YOUR CHILD CAN PARTICIPATE IN AWANA ACTIVITIES AT KENTUCK BAPTIST CHURCH
WE LOVE YOUR CHILD! HOWEVER, IF YOUR CHILD IS EXPERIENCING FLU-LIKE SYMPTOMS INCLUDING BUT NOT LIMITED TO, COUGH, FEVER, CHILLS, FATIGUE, MUSCLE ACHES, DIARRHEA, HEADACHE, SORE THROAT, CONGESTION, RUNNY NOSE, NAUSEA, VOMITING, OR SHORTNESS OF BREATH PLEASE DO NOT BRING THEM TO AWANA.
Name of Child

First NameLast Name
Does your child have any medical or physical condition that would prohibit him/her from participating in any AWANA activity? Select Yes or No
If Yes, Please explain:
In case of serious illness or injury, and you cannot be reached, the following information is needed:
Child's Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Doctor

First NameLast Name
Phone Number (Doctor)
Format: (000) 000-0000.
Insurance Company
Policy Number
Responsible person who can make a decision in your absence:
Name (Responsible Person)

First NameLast Name
Phone Number (Responsible Person)
Format: (000) 000-0000.
Relationship to Child
I give permission for ________________________ to participate in all games, all trips or all events which the AWANA program of Kentuck Baptist Church may sponsor. These activities may take place on or off the church property. I further understand that I will be notified of any off-church property activities ahead of time. Understanding that reasonable care and precautions will be taken, I release Kentuck Baptist Church, its membership, its trustees or any AWANA leader from responsibility should an accident occur.

First NameLast Name
Further, I give permission for ________________________ to be given appropriate medical care in case of an emergency and I will assume responsibility for payment of the physician's and/or hospital bill.

First NameLast Name
By entering your name below you are digitally signing this document

First NameLast Name
Signature of Parents
Date (First Signature)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
By entering your name below you are digitally signing this document

First NameLast Name
Signature of Parents
Date (Second Signature)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Cubbies Registration 2026 - 2027

3 Years (Potty Trained) - Pre K

OFFICE USE ONLY

PERMISSION AND MEDICAL RELEASE FORM

In case of serious illness or injury, and you cannot be reached, the following information is needed:

Responsible person who can make a decision in your absence: