Register your child for the 2009-2010 AWANA Year!

Child's Name
Date of Birth
Age
Grade
Parent/Guardian Name(s)
Mailing Address
Street Address (if different from mailing address)
City/State/Zip Code
Phone 1
Phone 2
Email Address
Emergency contact other than parent/guardian
Emergency contact phone number(s)
Food/drug allergies
Medications taken on a regular basis
Any medical conditions of which we should be aware
Date
I have read and accept the Permission and Release statement
Permission and Release Statement

I hereby give permission for my child to participate in activities sponsored by the AWANA Club of First Baptist Church Grapeland for the club year of 2009-2010. I further give my permission for First Baptist Church Grapeland or its representatives/sponsors of the activity to secure needed medical treatment in the event that I cannot be reached for such permission. I release First Baptist Church Grapeland and its representatives/sponsors from liability for accident or injuries. I hereby accept all the risks of injury associated with the above mentioned activity in which my child is participating at First Baptist Church.