* = required information
Parent(s)*
Street Address*
City*
State*
MIALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip Code*
Home Church
Home Church City
Person(s) (other than parents) authorized to pick up the child(ren):
Name of Parent or Guardian 1*
Relationship to Child(ren)*
Email Address
Phone*
Text OK?
YesNo
Name of Parent or Guardian 2
Relationship to Child(ren)
Phone
Name of Energency Contact
Emergency Contact's Phone
First & Last Name of Child 1*
Child 1's nickname (if any)
Child 1's Birthdate*
Child 1's Gender*
MaleFemale
Grade Child 1 is entering this fall (September 2025)*
Pre-K/Not in SchoolKindergarten1st2nd3rd4th5th6th
Book Needed?
Uniform Needed?
Does Child 1 have any food allergies, medications, or other special needs?*
If yes, please list them:
First & Last Name of Child 2
Child 2's nickname (if any)
Child 2's Birthdate
Child 2's Gender
Grade Child 2 is entering this fall (September 2025)
Does Child 2 have any food allergies, medications, or other special needs?
First & Last Name of Child 3
Child 3's nickname (if any)
Child 3's Birthdate
Child 3's Gender
Grade Child 3 is entering this fall (September 2025)
Does Child 3 have any food allergies, medications, or other special needs?
First & Last Name of Child 4
Child 4's nickname (if any)
Child 4's Birthdate
Child 4's Gender
Grade Child 4 is entering this fall (September 2025)
Does Child 4 have any food allergies, medications, or other special needs?
Terms and Conditions
1. I understand that my child/children may participate in physical activites 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 Grace Baptist Church and any persons involved in the AWANA Club ministry.
2. In the event of an emergency that requires medical treatment for the above-named child/children, I understand that 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.
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 I grant permission for a photo of my child to appear in an unpublished club directory to be used by AWANA leaders only.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 a photo or photos of my child to appear among other general club photos aslong as there is no identifying information shown.
I agree:*
Today's Date*
