Fredericktowne Baptist Church Awana Clubber Registration
Please submit one form for each family 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
Persons (other than parents) authorized to pick up children:
#1 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)
*
None
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's Allergies (if applicable)
#2 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)
None
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's Allergies (if applicable)
#3 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)
None
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's Allergies (if applicable)
#4 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)
None
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's Allergies (if applicable)
#5 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)
None
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's Allergies (if applicable)
Childrens' Doctor's Name
*
First Name
Last Name
Childrens' Doctor's Phone
*
-
Area Code
Phone Number
Insurance Co & Policy Number
*
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. 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.
I have read and agree to the Terms and Conditions stated above:
*
Typed Signature of Parent/Guardian
Date Signed
*
-
Month
-
Day
Year
Submit
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