Parent First Name:
Parent Last Name:
Address:
City:
State:
Zip Code:
Family Church:
Persons authorized to pick up the children:
Home Phone:
Cell Phone:
Email Address:
Emergency contact Name & Number:
Children Information
Child 1 Name:
Birthdate:
Gender:
Grade:
School:
	Need Book: Need Uniform:
Child 2 Name:
Birthdate:
Gender:
Grade:
School:
	Need Book: Need Uniform:
Child 3 Name:
Birthdate:
Gender:
Grade:
School:
	Need Book: Need Uniform:
Child 4 Name:
Birthdate:
Gender:
Grade:
School:
	Need Book: Need Uniform:
Clubber Name and known allergies:
I am interested in helping:
	Weekly: Every other week: Monthly: For special events:
Note: All AWANA Club leaders and listeners must attend AWANA Orientation and Basic Training before working with the children.
Security code:	*

* indicates a required field

Terms and Conditions:
I understand that my chil/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 and hold harmless from any legal liability First Baptist Church of Gunter and any persons involved in the AWANA Club ministry.
	Yes:
In the event of an emergency that requires medical treatment for the aboved 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 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.Title
	Yes:
I grant permission for a photo of my child to appear in an unpublished club directory to be used by AWANA Leaders only.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 as long as there is no identifying information shown.
	Yes: No:
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.
	Yes:
I have read and agree to the Terms and Conditions stated above:
Parent Name:
Today's Date:
Security code:	*

* indicates a required field