AWANA Registration, Medical & Photography Consent
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Clubber #1 Name
Clubber #1 Date of Birth
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Clubber #1 Grade
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Clubber #2 Name
Clubber #2 Date of Birth
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Clubber #2 Grade
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Clubber #3 Name
Clubber #3 Date of Birth
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Clubber #3 Grade
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Clubber #4 Name
Clubber #4 Date of Birth
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Clubber #4 Grade
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Clubber Parent/Guardian Name(s)
Clubber Address (Street & City)
Parent Home Phone Number
Parent Cell Phone Number
Parent Preferred Method of Contact
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Alternative Contact Name
Alternative Contact Home Phone Number
Alternative Contact Cell Phone Number
Alternative Contact Preferred Method of Contact
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Medical or Food Allergies
Any Health Concerns
Physical or Mental Disabilities
Family Physician & Phone Number
Insurance Company & Policy Number
I/we herby consent to any hospital, medical or surgical care and treatment. As well as the administering of anesthesia determined by a qualified physician to be necessary for the welfare of my child while participating in the AWANA ministry activities of First Mennonite Church. If I am not reasonably available by telephone to give consent, I also give permission for my child to be transported by private vehicle in the event of an emergency. Unless otherwise designated we will transport to the Hutchinson Regional Medical Center. If any of the above information changes during this Awana Season I will notify the ministry director. *
I/we give permission for our child(ren), while under the direction/care of First Mennonite Church, Pretty Prairie, KS to have photos/videos/images taken, displayed, or used for record keeping, promotion, outreach, and celebratory purposes. I/we authorize church pastoral staff and leaders to photograph, video record, and use said media for church ministries. In this digital age the church takes many pictures of special events, activities, youth group, etc. We use these photos/videos/images to record, promote, and celebrate our church ministries through various venues including, but not limited to church website, Facebook, etc. *
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