Please register here to volunteer for the Haven City Discipleship Home Construction Project AWANA 2021/2022 Student Registration Child First Name * Child Last Name * Street Address * City * State * Zip * Age * Grade * School Church Affiliation * Paramount Baptist Church OtherOther None Please select the appropriate AWANA Club for your child * Puggles (Age 2) Cubbies (Ages 3 & 4) Sparks (K through 2nd Grade) T&T (3rd through 6th Grade) Parent/Guardian First Name * Parent/Guardian Last name * Email * Phone * Emergency Contact Name * Emergency Contact Phone * Family Physician Name Physician Phone Number Allergies (Please list) * Medical Conditions (Please list) * Who is authorized to drop off your child? * Who is authorized to pick up your child? * MEDICAL AUTHORIZARION: I give permission for my child to participate in all aspects of the Awana Program at Paramount Baptist Church. I give permission for my child to participate in Awana programs and games, and agree to this emergency medical release. Further, I understand my permission includes physical games that are structured and supervised, and that physical injury is possible with unforeseen circumstances. I (we) also understand that, in the event medical treatment is required, every effort will be made to contact me, however, if I cannot be reached, I give permission to the staff or leader to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child's well being. I (we) also understand that I am responsible for the cost of professional medical emergency care. This release form is completed and signed of my own free will with the primary purpose of authorizing medical treatment under emergency circumstances in my absence for the Awana Club Year 2021/2022. * Yes No MEDIA AUTHORIZATION: I do hereby grant permission to record/photograph and display any media, video, and/or film products into any work product used by Paramount Baptist Church and to use or authorize the use of such media or any portion thereof in any manner of media or any means, methods or technologies now known or hereafter to be known. * Yes No MEDICAL and MEDIA AUTHORIZATIONS - Parent/Guardian Signature Required * MEDICAL and MEDIA AUTHORIZATIONS - Date Required * Captcha If you are human, leave this field blank. Submit Should you have any questions about this project, please contact Dennis Welch at firstname.lastname@example.org, or the church office at 301.739.2821.