Child's Gender: ---MaleFemale
Date of Birth:
Child's Age: ---456789101112131415
Last School Grade Completed: ---Pre-kKindergarden1st2nd3rd4th5th6th7th8th
Brought to Awana by: Phone:
Emergency Contact: Phone:
Medication Taken on Regular Basis:
As a parent and/or guardian, I do herewith give permission for my child to participate in AWANA events or activities. I further give permission for AWANA adult leaders to seek appropriate medical attention in the event of a medical emergnecy. I fully understand that every effort will be made to contact me.