Child Information:

Child's Name:
Address:
City, State, Zip:
Grade:
Birth Date:
Home Church:

T-shirt Size: youth extra smallyouth smallyouth mediumyouth largeyouth XLadult extra smalladult smalladult mediumadult largeadult XL

Emergency Information:

Emergency contact person:
Emergency contact phone:
Who else may pick up the child?:

Parent/Guardian Information:

Parent/Guardian Name:
Your Phone #:
Your Email:
Preferred Contact Method:Text MessageEmail

Medical Information:

Special Medical Conditions:
Family Doctor and Phone:
Insurance Company:
Insurance Policy #:
- Medical Acknowledgement
By checking the box above, I acknowledge that I understand that my personal medical insurance is the primary coverage for all AWANA events this year. In the event of an emergency situation, I authorize the representatives of Evergreen Baptist Church to seek emergency care for my child.