AWANA 2023

Clubber Name

Address

Email Address

This address will receive a confirmation email

Grade Entering in Fall

Parent 1

Parent 1 Cell Phone

Parent 2

Parent 2 Cell Phone

Clubber Date of Birth

Emergency Contact and Cell Phone Number

Do you currently attend a church?

Yes No

If yes, please list the church your family attends:

MEDICAL INFORMATION
*** Please Note ***
This information is strictly confidential and is only required in case of unforseen medical emergency for your child's protection. Thank you for your cooperation.

If Other, please list:

Does your child have any allergies?

Yes No

If your child has allergies, please describe:

Does your child require medications that we should be aware of?

Yes No

If your child requires medication, please list:

Does your child have any restrictions?

Yes No

If your child has any restrictions, please describe:

AWANA ACTIVITY PARTICIPATION AGREEMENT By checking YES below, the participant (or parent/guardian, if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation of our hayride and caroling event. Except for gross negligence on the part of the sponsor, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent guardian) promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity.

YES to both Hayride and Caroling NO to both Hayride and Caroling YES to Hayride ONLY YES to Caroling ONLY Other

If OTHER selected, please specify.

AWANA 2023

Description

Please Fix the Following