Awana Registration

Personal Information
Child's Name
First Last
Date of Birth*
Age*
Grade*
Gender*
Parent/Guardian Name(s)
Mailing Address
Street Address (If different from mailing address)
City
State
Zip
Phone
Phone 2
Email
Emergency Contact Information
Name
Relationship to child
Phone
Alternate Phone
Medical Information
Food/drug allergies
Medication taken on a regular basis
Any medical condition of which we should be aware
Permission and Release
I hereby give my permission for my child to participate in activities sponsored by the Awana Club of First Baptist Church Grapeland for the club year of 2018-2019. I further give my permission for First Baptist Church Grapeland or its representatives/sponsors of the activity to secure needed medical treatment in the event that I cannot be reached for such permission. I release First Baptist Church Grapeland and its representatives/sponsors from liability for accident or injuries. I hereby accept all the risks of injury associated with the above mentioned activity in which my child is participating at First Baptist Church Grapeland.*
- Yes
- No
Signature of Parent/Guardian*
By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Date
Date Format: MM slash DD slash YYYY

Personal Information