Parent First & Last Names

Names will be printed next to registration form signature line.

Street Address

City

State

Zip Code

Email Address
A form confirmation email will be sent to this address

Home Phone

Cell Phone

Emergency Contact

Phone Number

Specific Food Allergies, Medical Allergies, Chronic Illness or other

As parent or guardian, I hereby give permission for my child to attend AWANA Club activities.  In the event of accident or injury, I will not hold AWANA Clubs International, Corinth Baptist Church, or individual ministers or leaders responsible.  I do herewith authorize treatment for the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, or cause disfigurement, physical impairment or undue discomfort if delayed.  This authority is granted after a reasonable effort has been made to reach me

Periodically pictures are taken of events in AWANA and are posted on our website or printed for club. We would like your permission to post and print such photos

Security of your child(s) is important to us.

The Awana leadership has my permission to dismiss my child to the following individual(s), if I am not able to pick up my children. If there is any pertinent information we need to know, pertaining to the pick up of your child(ren), please state below.  

Security of your child(s) is important to us - Supervision.

The Awana leadership has my permission to dismiss my child unescorted and unsupervised

I release and absolve T2 Ministry, Corinth Baptist Church or its employees, and all Awana volunteers from any responsibility or liability for any problem arising from there following my instructions recorded here.

YOUR SIGNATURE WILL BE REQUIRED AT REGISTRATION