AWANA Registration Form | First Baptist Church of Rogersville Mo

AWANA Medical Release and Pick Up Authorization

A Medical Release form is required at the beginning of each new AWANA year. Even if your child has been in the program for several years, we ask that you turn in a new form with updated information. Please fill the form out completely so we have the information necessary in case of an accident or emergency. Please note: Parents will be asked to complete the Medical Release form within the first two weeks of Awanas. After that time, they will not be permitted to participate in games until a completed form has been received. All children are to be picked up inside the FBC Family Life Center from their AWANA leader. Children will not be permitted to leave the building without appropriate supervision.

Name (Required)

Email Address (Required)

Name of Person Submitting Form (Required)

Child's Full Name (Required)

Child's Age (Required)

Child's Birthday (Required)

Grade in School (Required)

Child's or Student's Address (Required)

Phone Number (Required)

Cell Phone (Required)

Emergency Contact Name (Required)

Emergency Contact Phone Number (Required)

Allergies and Medical Information (Required) If no information or allergies, please write "None" (Required)

Child's Physician (Required)

Hospital to Use in Case of Emergency (Required)

Who may pick up the student at the end of each Cross Kids session? (Required)

The student will not be released to anyone not included

I give the First Baptist Church of Rogersville Missouri permission to use photographs of me or the child registered here, in its website or social media sites ( such as; Facebook and Instagram) or in its video used in its service. (Required)

I give my permission to use photographs as indicated above.

YES

Does the student currently attend church regularly? If so, where? (Required)

(website, friend, social media, church sign, church flyer)

How did you hear about FBC's AWANA Club Ministry? (Required)

By submitting this form, I agree that this release is completed and signed of my own free will with the purpose of authorizing medical treatment under emergency circumstances in my absence.

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Our Mission

To Know Him and To Make Him Known

First Baptist Church of Rogersville Missouri

101 W Center Street PO Box 79

Rogersville, MO 65742

417-753-2926

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