AWANA Registration

AWANA Registration

Emergency Contact

Alternate Contact

If you have insurance, your carrier will be billed for medical charges in the case of illness or injury.

Insurance Information

Health History

Medical and Liability Release Statement:

I understand that if medical intervention is needed, every attempt will be made to immediately contact the persons listed on this
form. If I cannot be reached in an emergency, I hereby give my permission to secure medical treatment for my child as deemed

I understand the Martensdale Community Church Awana Clubs will take all reasonable safety precautions and I understand the possibility of unforeseen hazards and I know the inherent possibility of risk.

I agree not to hold Martensdale Community Church, its Awana leaders or volunteers liable for damages, losses or injuries incurred by the subject of this form.

Coronavirus Notification:

If you decide to bring your child(ren) to the face-to-face verse time at the church, you are agreeing to notify Commander James or Laura Kruger about any positive Covid-19 test that may occur in your household. This will allow those that work with your child to be notified of the potential exposure to the virus. Personal information will be kept confidential.

By placing your name in the E-Signature box below you agree to the terms of this document. The E-Signature Act became law in 2000. Under this law, online “electronic” signatures have the same legal status as a written signature.

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