Please enter your Child's Information Below.
Age Requirements for Each Club:
Cubbies: 3 yrs (on or before Sept 1st) to 5 yr olds (not in kindergarten)
Sparks: Kindergarten to second grade
T&T: Third grade thru sixth grade
As a parent and/or legal guardian, I do herewith authorize treatment under the direction of any licensed physician of the above named minor in the event of a medical emergency, which in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to contact parent/guardian by telephone at the numbers given above.
As a parent/guardian, I assume full responsibility for any cost connected with such treatment and hereby release the church where the child attends AWANA Club and all of the leaders of the club from liability.
This form is completed and submitted of my own free will with the sole purpose of authorizing emergency medical treatment of my son/daughter in my absence.