Awana Registration

Your Name (required)

Full Address, City & Postal Code

Primary Phone Number & Name

Call or Text

Secondary Number

Call or Text

Your Email (required)

Alternate Emergency Contact Name & Phone Number

Allergies

Student's Name

Age

DOB:

Club: Cubbies(3-4Yrs), Sparks(K-2nd), T&T Girls(3rd-6th), T&T Boys(3rd-6th), Jv Trek(7th-8th)

Grade

In case I/we cannot be reached during an emergency, I/we by undersigning give permission for my/child to be treated by a licensed physician if this emergency might endanger his/her life and/or cause disfigurement, physical impairment or undue discomfort by delaying treatment. Said physician is to administer whatever care is necessary, including anesthesia. By undersigned assumes responsibility for any costs connected with such treatment and herby releases Awana Clubs International, and Cedar Hills Baptist Church and the driver of any vehicle transporting my child to to a supervised Awana outing, from liability. This release form is completed and checked of my/own free will and with the sole purpose of authorizing medical treatment under emergency circumstance in my/our absence. (Put your Name and Date.)

Your Message


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