Child’s Name ______Prefers/Nickname______

Address ______City/State/Zip ______

Home Phone ______Birth Date ______ Boy  Girl

Father (Guardian) / Mother (Guardian)
Cell Phone
Work Phone
Email Address

What phone number should we use? ______


List any food allergies or health concerns ______

Health History (please check all that apply)

 Hay Fever Diabetes Nervous Disorders Asthma

 Insect Sting Allergy Physical Handicap ADD/ADHD Chronic Digestive Problems

 Heart Conditions

Any Activity Restrictions? (List) ______

Custody Concerns?  Yes Please notify class leaders regularly. Please include relevant details regarding custody or security concerns ______

Behavioral Concerns  Yes ______


Name of Church Regularly Attended ______City______

Pastor’s Name ______How Often Does Family Attend ______

Awana Enrollment and Dues Policy: There is a cost for Awana enrollment, these dues help cover the cost of awards, the Awana store and activities throughout the year. The first handbook is provided by the church; however if the handbook is lost, damaged beyond repair or clubber completes and starts another handbook, an additional cost of $8.00 is required before they receive a new handbook. If financial assistance is needed please contact Sardis Baptist Church at 568-3996. Limited/Full scholarships may be available. Typically a scholarship is ½ cost of the annual due. To receive full benefits of this program, pre-payment or financial assistance must be received at the beginning of the program.

Release Form for Use of Personal Images (Pictures / Videos)

From time to time during the club year videos, photographs, and/or slides will be taken of our Clubbers. These will be used for publicity purposes only. Your signature below grants permission for Sardis Baptist Church to use videos, photographs, and/or slides of your child for publicity purposes and/or publishing to our website.


Name of Parent/Guardian Date

Emergency Medical Treatment Consent (must be signed by parent or legal guardian)

I, ______, do hereby state that I am the (a) parent and/or guardian having legal custody of the minor child listed on front page. I give consent for a responsible adult at the Awana clubs at Sardis Baptist Church (SBC) to administer appropriate first aid to my child when needed. I also give consent to secure additional emergency treatment for my child, under the following conditions: reasonable effort has been made to find me at the church or at home, SBC volunteers, the commander or SBC staff determines that care is needed prior to probable return of the parent/guardian to pick up the child. I understand it is my responsibility to notify the classroom leaders as to where I can be reached in the event of an emergency.


Parent/Guardian Signature Date

We realize that no activity is without the possibility of unforeseen hazards which could result in injury to an individual. For this reason, Sardis Baptist Church provides supervision and directions for the safe conduct of activities. Sometimes these directions are not followed or are disregarded by children in our program resulting in injury. As a parent or other responsible person, Sardis Baptist Church expects you to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and an enjoyable time. ______(Your Initials)

By signing this form you as a parent, guardian or other responsible person agree to assume the risks and hazards which may be inherent in all activities, you also agree to absolve and hold harmless Sardis Baptist Church and/or it’s owners, agents or employees for damage, losses or injuries to their person(s) or property undersigned. Sardis Baptist Church carries accident insurance as secondary insurance to individual or family coverage. I do hereby release, forever discharge and agree to hold harmless Sardis Baptist Church and the directors thereof from any and all liability, claims or demands for personal in injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating above described activity. The undersigned further hereby agrees to hold harmless and indemnify said church its directors, employees and agents for any liability sustained by said participant, including expenses incurred attendant thereto.


Parent/Guardian Signature Date