Fields marked with an * are required.
Child's Date of Birth*
Child's Gender *
Child's Grade *
T-Shirt Size *
Parent Phone Number (1)*
Parent Phone Number (2)*
Person(s), other than parents, authorized to pick up child. *
Emergency Contact During Club Time (other than parents) *
Emergency Contact Phone*
List any allergies, medications, or special needs for your child.
ACCIDENT RELEASE: I understand that my child(ren) 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, Greenwell Springs Baptist Church and any persons involved in the AWANA Club ministry.*
AUTHORIZATION TO ADMINISTER EMERGENCY MEDIAL TREATMENT: In the event of an emergency that requires medical treatment for the above named child, I understand every effort will be made to contact me or 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.*
PHOTO RELEASE: I hereby give my consent and authorization to Greenwell
Springs Baptist Church, its employees, volunteers, and other representatives, to take photographs of my said child and to use the photograph(s) on
the website of Greenwell Springs Baptist Church and/or to promote future AWANA Clubs and other activities of Greenwell Springs Baptist
Church. I warrant that I have the authority to give this consent and I hold Greenwell Springs Baptist Church, its employees, volunteers, and other
representatives harmless from any claim(s) of any nature arising out of such use of the photographs of my minor child.*
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.*
A parent/guardian must attend orientation and physically sign-off on this information in order to be registered for AWANA Clubs.