AWANA SIGN UP

Child's Name (Please fill out a separate form for each child if you have more than one attending) *

First

Last

Multiple Choice *

Boy
Girl

Date of Birth *

Grade *

School *

Name of Parent or Guardian (First & Last) *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone 1 *

Phone 2

Email *

Emergency Contact 1 *

Emergency Contact 1 Phone # *

Emergency Contact 2 *

Emergency Contact 2 Phone # *

Allergies/Medical Concerns

I HEREBY AGREE TO THE WAIVER *

Yes
No

I hereby release Good News Bible Church (GNBC) and its volunteer or paid employees from all liabilities that may occur while participating in this program. I give permission for my child to attend the AWANA program, and certify that they are in good health, free from communicable illnesses and are able to participate. If I cannot be contacted, and there is a medical and/or surgical emergency, I give permission to the physician/hospital selected by The GNBC leadership to hospitalize and/or secure proper treatment for my child as named above. I understand that if my child becomes ill or injured, my own health insurance coverage (including deductible) applies. I also give permission to use my child’s image/video in any publication materials (online or print) that could possibly be used to help promote the Ministry of GNBC.

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