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Awana Cubbies 2019/20 on Wednesday, September 4, 2019

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175.00 
160.00 
175.00 
*Birthdate:
*Age by September 1, 2019 (MUST turn 3 by Sept. 1st):
YOUR CHILD MUST BE COMPLETELY POTTY TRAINED BEFORE ENTERING CUBBIES, NOT IN PULLUPS:
*Gender:
Uniform Vest Size (this will be used for 3's and 4's):
Food Restrictions:
Special Needs (Asthma, allergies, physical limitations, custody concerns, etc.):
Other Concerns/needs:
*Mom's Name:
*Mom's Cell:
*Dad's Name:
*Dad's Cell:
I request my child to be in the same room as (All attempts will be made to accommodate, but not guaranteed):
*Will a parent/guardian be volunteering in Awana?:
If so, where?:
*If not volunteering, a number where you can be reached during Awana:
*Name of church YOU ATTEND for Worship:
*Alternate Contact:
*Relationship:
*Alternate Contact Phone:
Authorization: I do hereby state that I have legal custody of the aforementioned minor. I grant my authorization and consent for Grace Baptist Church to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize Grace Baptist Church to summon any and all professional emergency personnel to attend, transport, and treat the minor.:
By typing my first and last name in this box, I am signifying that I am the parent or guardian for the child listed above and have the authority to enter into this agreement on their behalf:
*Signature:
*Today's Date: