Awana Nursery

For Leader Volunteer Children Only

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
Child's Date of Birth:
*Mom's Name:
*Mom's Cell:
*Dad's Name:
*Dad's Cell:
*Where is parent serving in Awana or on campus?:
*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.:
Pictures may be taken during the event for church use:
This form, when completed, may be photocopied:
Special Needs (Asthma, allergies, physical limitations, custody concerns, etc.):
Food Restrictions:
Other concerns/needs:
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:
*Parent/Legal Guardian Signature:
*Date:
Submit Form