Awana 2023-2024 Trinity Baptist Church

Trinity AWANA Club 2023-2024 Wednesday Nights during school year from 6:30PM-7:45PM each week. We have clubs for preschool and elementary aged children. Puggles is our club for 2 yr olds. Cubbies is our club for 3 and 4 yr olds. Sparks is our club for K-2nd graders. T&T is our club for kids 3rd grade-6th grade.

Participant Information

Participant's Name

Gender

Please select one option.

Male Female

Birthdate

Grade for 2023-2024 School Year

Please select one option.

2 Year Old 3 Year Old 4 Year Old Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th 6th

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Authorized Pickup (1)

Authorized Pickup (2)

Permission Release

Please select all that apply.

As parent or legal guardian, I hereby give permission for my child (listed above) to participate in activities offered by—or on the campus of—Trinity Baptist Church.

Medical Information

Emergency Contact Name (1)

Emergency Contact Phone (1)

Emergency Contact Name (2)

Emergency Contact Phone (2)

Allergies, Medical, & Special Needs

Please select one option.

YES NO

Please list any allergies, dietary restrictions, medical or health problems that would affect his/her participation in any activities:

List any medications taken:

Name of child's physician and any other physician who can be consulted in the event of emergency or medical problems involving htis child when parent/guardian cannot be reached:

Physician Address

Physician Phone

Insurance Information

Name of Insurance Company

Insurance Address

Name of Primary Policy Holder

Policy Number

Phone Number of Insurance Company

Medical Release

***PLEAE BE SURE TO RETURN TO THIS PAGE AND HIT "SUBMIT" BUTTON TO FINALIZE REGISTRATION***

Use this link to esign medical release form (required for participation):

Medical Release Form

Awana 2023-2024 Trinity Baptist Church

Description

Please Fix the Following