Fredericktowne Baptist Church 2018-19 Awana Clubber Registration

Fredericktowne Baptist Church 2018-19 Awana Clubber Registration

Please submit one form for each child you are registering.
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Email *
example@example.com
Parent/Guardian Phone Number *

- Area Code Phone Number
Emergency Contact Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Persons (other than parents) authorized to pick up child:
Child's Name *

First Name Last Name
Child's Gender *

Male Female
Child's Birth Date *

- Month - Day Year
Date
Child's Grade (entering this school year) *
Child's Doctor's Name *

First Name Last Name
Child's Doctor's Phone *

- Area Code Phone Number
Insurance Co & Policy Number *
Child's Allergies (if applicable)
I am interested in helping:

Weekly Every other week Monthly For special events
Terms and Conditions

1) I understand that my child 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, Fredericktowne Baptist Church and any persons involved in the Awana Club ministry. 2) In the event of an emergency that requires medical treatment for the above named child, I understand every effort will be made to contact my emergency contact. However, if I/we cannot be reached, I give my permission to the Awana volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child. 3) I grant permission for a photo of my child to appear on the Fredericktowne Baptist Church website and among general club photos as long as there is no identifying information shown. 4) I grant permission for my child to travel to/from Awana Club events with an adult leader. Any such event will be clearly communicated with me beforehand.
I have read and agree to the Terms and Conditions stated above: *
Typed Signature of Parent/Guardian
Date Signed *

- Month - Day Year
Should be Empty:

Fredericktowne Baptist Church 2018-19 Awana Clubber Registration

Terms and Conditions