Awana Clubs @ SMBC ~ 2023-2024

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Each child should be registered separately. We look forward to a great year of Awana Clubs @ SMBC!!

Clubber's Last Name *

Clubber's First Name *

Clubber's Grade (23-24 School Year) *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Preschool (3 & 4 years old as of 9/30/23, SMBC members only)

Other:

Clubber's Gender *

Male

Female

Clubber's Date of Birth *

YYYY

Street Address *

City, State *

Zip-code *

Cell Phone # *

Email Address *

Did your child participate in Awana @ SMBC last school year? *

Yes

Name of the church you regularly attend, if any: *

Allergies or any other info parents would like to share that will help us minister to your child during Awana Clubs:

I hereby grant Smith Memorial Baptist Church permission to use/post photographs of my child for use on their website, social media and/or informational/ promotional purposes (no names or personal information will ever be used). *

Yes

Name of Event: Awana Clubs, Wednesday Nights (Sept, 2023 – June, 2024), 5:45 p.m. – 7:30 p.m. I (We), the parent(s) of this registered minor, do hereby authorize adult volunteers of Smith Memorial Baptist Church as agents for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an emergency clinic or hospital. I further release from any liability Smith Memorial Baptist Church, any of its ministries or leaders in the event of an accident en route, during, or returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence. *

Agreed

I do not agree and my child will not be participating in Awana Clubs.

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