Date (required)

    First and Last Name (required)

    Gender (required) FemaleMale

    Home Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Phone Number

    E-mail Address (required)

    Child's Age (required)

    Child's Grade (required)

    Child's DOB (required)

    Church Home

    (If there is no church home, please enter None)

    Parent or Guardian Name

    Emergency Contact

    Emergency Contact Telephone (required)

    Emergency Contact E-mail (required)

    Parent/Guardian’s Release Statement


    My child (listed above) has my permission to participate in the AWANA Ministry and all of the activities sponsored by the AWANA Ministry of the First Baptist Church of Highland Park. My child is physically able to participate in these events. In the unlikely event that an accident or an emergency occurs, I understand that every effort will be made to notify me. If I cannot be reached and such becomes necessary, I hereby grant permission to the physician selected by the adult in charge of the AWANA event to secure proper treatment for my child named above. Further, I release the AWANA Ministry and the ministry leaders, and the First Baptist Church of Highland Park from any and all liability in the unlikely event of an accident or injury.

    By checking this box I acknowledge that I have read and consent to the statement above. - (I Consent)

    Date

    Parent/Guardian’s Release Electronic Signature (required)