AWANA Club Registration/Activity Permit

Please register one child per form.

To Whom It May Concern: As a parent and/or guardian, I do herewith authorize treatment under the direction of any licensed physician of a medical emergency which, in the opinion of the attending physician, may endanger my child's life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the number(s) listed below.

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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 absences.

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Please provide at least one phone number.

Other contact(s) in case of emergency:

Thank you for registering your child for AWANA for the 2022-2023 club year! See you on Wednesday, September 14th at 6:30 P.M.