MBC AWANA Registration Form

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2023-2024

Parent/Guardian Name *

Parent Phone Number *

Parent Street Address *

Parent Mailing Address (if different from Street Address)

Parent Email Address *

Names of those other than the parent authorized to pick up child(ren) . *

First and Last Name of 1st Child attending AWANA *

Birthdate of 1st Child attending AWANA *

YYYY

Sex of 1st Child attending AWANA? *

Male

Female

Does this child have any allergies? *

Does this child have any medical needs we should know about? *

Name of 2nd Child attending AWANA. *

Birthdate of 2nd child attending AWANA

YYYY

Sex of 2nd child attending AWANA

Male

Female

Clear selection

Doe this child have any allergies? *

Does this child have any medical needs we should know about? *

First and Last Name of 3rd Child attending AWANA *

Birthdate of 3rd child attending AWANA

YYYY

Sex of 3rd Child attending AWANA

Male

Female

Clear selection

Does this child have any allergies? *

Does this child have any medical needs we should know about? *

First and Last Name of 4th Child attending AWANA *

Birthdate of 4th Child attending AWANA *

YYYY

Sex of 4th Child attending AWANA

Male

Female

Clear selection

Does this child have any allergies? *

Does this child have any medical needs we should know about *

Liability Release and Emergency Medical Treatment Agreement. Your Signature indicates agreement. This form must be signed for your child to participate.

For all of my children that I have registered for AWANA, I give my permission to attend AWANA at Mexia Baptist Church on Wednesdays from 5:45-7:00 pm. I UNDERSTAND AND DO HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED BY MY SON/DAUGHTER THROUGH PARTICIPATING IN THE ABOVE ACTIVITY. I agree that I hereby hold harmless and waive any and all claims against Mexia Baptist Church, its staff, and its leaders, for any accident, bodily or personal injury, damage to or loss or theft of any property, illness, or death of any person, including without limitation demands, liabilities, damages, judgments, losses, costs, expenses and/or penalties, including attorney’s and consultant’s fee and disbursements, which arise out of joining the AWANA Club at Mexia Baptist Church. I further state that I have carefully read the foregoing release and know the contents thereof. I am signing this release as an act of my own free will. This is a legally binding agreement which I have read and understand.

Please sign on the line below and provide the name of your doctor, your doctor's phone number, your type of medical coverage, the policy number and any other helpful information.

The cost for AWANA is $15.00 per child. You can pay through the church office, online through the church website (be sure to designate it is for AWANA), or you can bring your money to the first meeting in August. Other fees are optional. T-shirts are $17.00 and Bible Bookbags are $10.00. If you would like a t-shirt or Bible Bookbag, please note it below and include the size for the t-shirt and which child you are purchasing it for.

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