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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.

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.

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.

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