FBC Buda – Awana Registration Form

Today's Date:

Parent E-mail:

Child's Name:

Child's Age:

Child's Birthdate:

Child's Grade:
—Please choose an option—Pre-KK12345

My child will participate in the following club: (please select one)
—Please choose an option—Cubbies (3&4 year olds)Sparks (K-2nd grade)T&T (3rd-5th grade)

Home Telephone:

Address:

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Parent/Guardian #1 (Required)

Parent/Guardian #2 (If Applicable)

Emergency Contact 1: Name & relationship to child (Required)

Emergency Contact 2: Name & relationship to child (If Applicable)

Individual(s) authorized to pick up your child:

May we have permission to photograph your child? (Photos will only be used in church presentations.)
YesNo

My child has my permission to participate in the AWANA Games hosted by First Baptist Church in Buda, Texas.
YesNo

Allergies

Medications

Name of Child's Physician

Physician's Phone Number

Designated Hospital for Child

Insurance Provider Covering Child

Insurance Policy Number Covering Child

Physical Impairments, Chronic Illnesses (Heart, Epilepsy, etc.), Autistic, ADHD, Learning Disabilities or any other information that would help us minister effectively to your child.

MEDICAL EMERGENCY CARE INFORMATION:

By submitting this form I affirm that I understand and agree with the following statements...

1. I understand that the above named child may participate in physical activities such as those held during Game Time. I understand that with any physical activity, there is a risk of injury. I fully accept this risk and do not hold any legal liability to: First Baptist Church, Buda, Texas and/or any
persons involved in AWANA Clubs international, and/or the AWANA Clubs at First Baptist Church, Buda, Texas.

2. In the event of an emergency that requires medical treatment for the above named child, I understand that every effort will be made to contact me or my emergency contact. However, if I cannot be reached, I give my permission to an AWANA Leader/ Parent to secure the services of a licensed physician/or qualified medical/ emergency professional to provide the necessary care for my child’s wellbeing. I assume full responsibility for all costs connected to any accident or treatment of my child.

3. I grant permission for my child to travel to/from any/all AWANA events with an adult Leader/Parent. Any such event will be clearly communicated with me before the event.

I acknowledge and agree.