Club Year: 2016-2017

Parent/Guadian

Name:
Address:
Home Church:
Home:
-
Cell:
-
Work:
-
Email:
If needed, where can we find you (parent/guardian) during Awana?

Emergency Contact
(Other than parents)

Emergency Name:
Cell Phone:
-
Home Phone:
-
Other:
Persons (other than parents) authorized to pick up the children:

Child's Name

Child 1:
Child 2:
Child 3:
Child 4:
Child 5:

Gender

1:
2:
3:
4:
5:

Grade

Grade Child 1:
Grade Child 2:
Grade Child 3:
Grade Child 4:
Grade Child 5:

Allergies/Meds/Special Needs

1
2
3
4
5

Terms and Conditions

  1. I understand that my child/children 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. By signing this permission slip, I release and hold harmless, The Tabernacle, its pastors, trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely, even injury resulting in death.

  2. In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I authorize the staff, Awana volunteers, or designated medical professionals 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.

  3. I grant permission for a photo of my child to appear in an unpublished club directory to be used by Awana Leaders only. I also give permission for photo(s) of my child to appear among other general club photos, on The Tabernacle website, and on The Tabernacle Awana Facebook page as long as there is no identifying information shown.

  4. 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.
Electronic Signature of Parent/Guardian*
Word Verification:
Date: