Awana - Madison Bible Church

1 Step 1

Madison Bible Church

Awana Registration Form

Child's Information

Child's Nameyour child's full name

Home Church (or N/A)your full name

Birth Date

Age (By Sep 1)

Please select the age/grade level as of Sep 1st.

(Note* Cubbies must be pottie trained to register.)

Parents/Guardian Information

Full Name

Your Email Addressa valid email

Phone Number

Street Address

City

ZIP

Child Pick-Up

Madison Bible Church (MBC) Child Protection policy requires that a pre-designated adult (over 18) check out Pre-K to 5th grade children at the end of club night.

Please list the names of any additional persons to whom your child can be released:your full name

Activity Consent

I give permission for my child to participate in physically demanding activities such as, running, crawling, relay races, and throwing/catching objects. I understand that close-toed shoes are required for my child to participate in Game Time.

I Consent:

YesNo

Medical Consent

I authorize treatment under the direction of any licensed physician for the minor listed above in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. I assume the responsibility for any costs connected with such treatment.

I Consent:

YesNo

Please List Allergies:more details

0 /

Does your child have any medical conditions or accommodations that we need to be aware of in order to make their Awana experience (including game time) more safe and enjoyable?pick one!

YesNo

Please explain:more details

0 /

Liability Waiver

I understand that there are risks associated with Awana club activities, and that the minor listed above could get hurt while participating in the program. But I still want this minor to participate, so I waive and release MBC (including its employees and volunteers) and Awana (including its employees and volunteers) from any and all liability.

By typing my name here, I acknowledge this as my electronic signature for the above the information.

Typed: Parent/Guardian Signature

Date

FormCraft - WordPress form builder

​

Madison Bible Church

Please select the age/grade level as of Sep 1st.