AWANA 2018-2019

Please fill out this form and click submit. Please fill out one per child.

Thank you for helping us care for your children!
The AWANA Orientation Night is Wednesday, September 12 at 6:30pm.
Child's Information

 
 
 
 
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Household Information

 
 
 
 
 
 
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Emergency Contact Information

 
 
 
Parental Consent

I recognize that Menomonie Alliance Church uses photographs, voice, and video images of events in their publicity/informational materials and I hereby grant permission for photo/video images of my child to be taken and used for such purposes.

My child may receive first aid treatment by staff/volunteers if he/she becomes ill or is injured while in the care or under the supervision of Menomonie Alliance Church.

I understand that my child should not attend activities when knowingly ill or recently exposed to a contagious disease.

I authorize treatment, by a qualified and licensed medical doctor, of the minor listed above in the event of any medical emergency which, in the opinion of the attending physician, is necessary and I/we cannot be reached after reasonable effort has been made to secure my personal consent.

Any medical expenses are the responsibility of the participant and their insurance carrier.
I, the parent/guardian of the registrant, a minor, recognize the possibility of physical injury associated with AWANA at Menomonie Alliance Church. In consideration for Menomonie Alliance Church accepting the registrant for its programs and activities, I hereby release, discharge, and/or otherwise indemnify Menomonie Alliance Church, its employees and associated personnel, including the owners and directors of facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs.
 
 
Payment

$25.00
 
 
 
 
 
 

Description

Please fill out this form and click submit. Please fill out one per child.

Thank you for helping us care for your children!