AWANA

ATLANTIC BAPTIST CHURCH

Medical Release/Persmission Slip

Child's Name

I) I hereby give permission for my child to participate in the activities of the AWANA CLUBS. I understand that my child will take part in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability Atlantic Baptist Church and any persons involved in the AWANA Ministry.

2) In the event of an emergency that requires medical treatment for the above named child, I understand that every effort will be made to contact me. However, if I cannot be reached, I give permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all cost connected to any accident or treatment of my child.

3) I grant permission for my child's photo to be used for church use only (bulletin boards, newsletters, bulletin inserts, slideshows, and possibly our website.

I have read and agree to the Terms and Conditions stated above.

*Online registrants MUST sign this form on first night.

Parent/Guardian Signature

Date

Medical and Contact Information

Does your child have any of the following?

Allergies Chronic Illnesses

Physical limitations or any other conditions Yes No

Please specify

Family Physician Physician Phone

Please attempt to contact the following person if the parent/guardian is not available.

Name Relationship to Child

Phone Cell Phone

Other