Fredericktowne Baptist Church Awana Clubber Registration

Fredericktowne Baptist Church Awana Clubber Registration

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

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

Area CodePhone Number
Emergency Contact Phone Number *

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Persons (other than parents) authorized to pick up children:
#1 Child's Name*

First NameLast Name
Child's Gender*

MaleFemale
Child's Birth Date*

MonthDayYear
Date
Child's Grade (entering this school year)*
Child's Allergies (if applicable)
#2 Child's Name

First NameLast Name
Child's Gender

MaleFemale
Child's Birth Date

MonthDayYear
Date
Child's Grade (entering this school year)
Child's Allergies (if applicable)
#3 Child's Name

First NameLast Name
Child's Gender

MaleFemale
Child's Birth Date

MonthDayYear
Date
Child's Grade (entering this school year)
Child's Allergies (if applicable)
#4 Child's Name

First NameLast Name
Child's Gender

MaleFemale
Child's Birth Date

MonthDayYear
Date
Child's Grade (entering this school year)
Child's Allergies (if applicable)
#5 Child's Name

First NameLast Name
Child's Gender

MaleFemale
Child's Birth Date

MonthDayYear
Date
Child's Grade (entering this school year)
Child's Allergies (if applicable)
Childrens' Doctor's Name*

First NameLast Name
Childrens' Doctor's Phone *

Area CodePhone Number
Insurance Co & Policy Number*
Name of Church You Currently Attend*
I am interested in helping:

WeeklyEvery other weekMonthlyFor 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. 5) FBC Awana has a weekly snack time. If, for any reason, I do not wish FBC to provide my child with a snack, I will provide one for my child and leave it with the club leader.
FBC reserves the right to deny registration for any reason.

PLEASE NOTE:

ALL CHILDREN MUST BE POTTY TRAINED TO PARTICIPATE IN THE FBC AWANA PROGRAM.
I have read and agree to the Terms and Conditions stated above:*
Typed Signature of Parent/Guardian
Date Signed*

MonthDayYear
Should be Empty: