Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Secondary Phone

If applicable

(###)

###

####

Permission for Photography/Videography *

Yes, my child(ren) can be photographed or videoed to promote Awana Clubs on our website and in church.

No, my child(ren) cannot be photographed or videoed to promote Awana Clubs on our website and in church.

Consent *

I agree to the following. 1) I understand that my child(ren) may be involved in physical activity during Game time. As with any activity, there is a risk of injury. I fully accept this risk and hold harmless against any legal liability, First Baptist Church Whitewright and any persons involved with the ministry. 2) In the event that an emergency requires medical treatment for the above named child(ren), I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give permission for First Baptist Church Whitewright volunteers to secure the services of emergency medical help necessary for my child’s well being. I assume all responsibility for the costs of any accident and any treatment.

Agree

Child #1 Full Name *

First Name

Last Name

Child #1 Birthday *

MM

DD

YYYY

Child #1 Gender *

Female

Male

Child #2 Full Name

First Name

Last Name

Child #2 Birthday

MM

DD

YYYY

Child #2 Gender

Female

Male

Child #3 Full Name

First Name

Last Name

Child #3 Birthday

MM

DD

YYYY

Child #3 Gender

Female

Male

Child #4 Full Name

First Name

Last Name

Child #4 Birthday

MM

DD

YYYY

Child #4 Gender

Female

Male