AWANA REGISTRATION FORM

Child's Name

Awana Club:

Puggles (2 yearl-olds) Cubbies (3, 4, & Prek) Sparks (K, 1st & 2nd grades) T&T (3rd, 4th & 5th grades) Trek (6th, 7th & 8th grades)

Birthday

Gender

Boy Girl

School

Address

T-Shirt Size

Kids Extra Small Kids Small Kids Medium Kids Large Kids Extra Large Adult Small Adult Medium Adult Large

Parent/Guardian/Emergency/Other Contact Information:

Name 1

Relationship to Child

Phone

This address will receive a confirmation email

Authorization to pick up child?

Yes No

Name 2

Relationship to Child

Phone

This address will receive a confirmation email

Authorization to pick up child? Yes No

Name 3

Relationship to Child

Phone

This address will receive a confirmation email

Authorization to pick up child? Yes No

Do you have a church home? Yes No

If yes, where?

Current Medical Information Allergies/Sensitivities:

Other Information

MEDICAL RELEASE INFORMATION

As a parent / guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his / her life, cause disfigurement, or undue comfort if delayed. This authority is granted after all reasonable effort has been made to reach me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence for the Awana Club year Sept 9, 2022 through May 26, 2023.

Signed:

Father / Mother / Guardian

Father Mother Guardian

Date

PAYMENT INFORMATION

Annual Fee is $35.00.

Please make checks payable to

Mandarin Baptist Church or MBCSFV

("Awana" in note section)

Cash accepted also

AWANA REGISTRATION FORM

Description

Please Fix the Following