AWANA Clubber Registration

Child's Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender

Male
Female

Birth Date*

Current Age*

T-Shirt Size

School Grade*

Parent(s) or Guardian(s) Name:*

Home Phone*

Cell Phone

Email*

Church You Attend?

IN CASE OF EMERGENCY- MEDICAL

Emergency Contact*

Emergency Contact Phone*

Known Allergies

Additional Medical Info

AWANA CLUBBER REGISTRATION FORM I/We give permission for my/our children to attend AWANA Club at First Baptist Church of Joelton, TN for the duration of the current club year. I/We further give permission for my/our clubber (’s) AWANA leader to contact him/her via the phone of through the mail as it pertains to club functions or concerns. I/We also give permission for photos of my/our child to be used in church media and promotional materials. IN CASE OF EMERGENCY---It is the policy of First Baptist Church Joelton in case of illness, accident, other emergencies affecting any boy or girl attending a church function or activity, to make reasonable attempt to promptly get in touch with the parent or guardian. It is required that we have you approve the following statement: I/We do hereby authorize First Baptist Church Joelton, its representative, to select transportation to their chosen licensed physician who may use upon and administer to the said child while attending him/her: x-ray examination, anesthetic, medical; or surgical diagnosis or treatment, order injections, or hospitalize, as in the option of such physician is deemed necessary or advisable. These shall be in effect from the date of registration till the end of the current club year.

Agreement*

Yes
No

OFFICE USE ONLY

Class Assigned to:

Puggles (2 yr olds)
Cubbies (3's, 4's and PreK)
Sparks - Kindergarten
Sparks - 1st Grade
Sparks - 2nd Grade
T & T - 3rd/4th Grade
T & T - 5th/6th Grade