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Child's Information
Name First:
Last:
Gender
Birth Date:
Age (as of Sept. 1st):
Grade (as of Sept. 1st):
List Allergies
Parent/Guardian Information
Name First:
Last:
Cell Phone:
Name First:
Last:
Cell Phone:
List any special concerns or instructions:
List the names of people who have your permission to pick up your child:
AWANA Club Activity / Medical Release Form
I give my permission for my above-named child to participate in AWANA activities for the current school year. While expecting
the AWANA staff to look after the safety of my child, I hereby release them and Evangel Baptist Church from liability for any
injury or illness that my child may sustain during club meeting and/or additional AWANA-sponsored activities.
I authorize the adult staff of the AWANA Clubs to obtain whatever emergency medical attention might be necessary for the
above-named child in the event I cannot be reached.
Picture/Photo Release
I,
as the parent/or legal guardian of the above child,
For Evangel Baptist Church, 3605 Lorraine Rd.,Lakewood Ranch, FL, 34211, to take pictures of my child (film,
digital and video) while participating in church activities and post them in church brochures or on any
website or social media set up by and/or related to Evangel Baptist Church. I understand my child’s
pictures will not be used for any other purpose without first giving notification and seeking further
consent for use.
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