Awana Clubs Registration Form
Date of Birth
City, State, Zip
Home Church (if any)
Parent or Legal Guardian's Name
Name of Adults Who Can Pick Up Your Child (Other Than Parents)
Does your child have any allergies or medical concerns?
If yes, please describe anything we need to know, especially food allergies, and any behaviorial concerns.
Emergency Contact (if parent cannot be reached)
Medical Release I, the parent or guardian of the child listed above, a minor, do hereby authorize adult volunteers of Glenview Alliance Church as agent(s) to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability any of its ministries or leaders in the event of an accident in route during and returning from the above mentioned event. This agreement does not apply for intentional misconduct or gross negligence. I also give my permission to allow my child’s image to be recorded by photograph or video and used during Awana or for future advertisement for Glenview’s children’s ministry events.
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