Awana Club

In the event that I, the parent/guardian, am unable to pick up my child, I authorize the following adults listed below to pick up him/her from Jerusalem Chapel Awana Club. I understand this must be an adult (no siblings may pick up my child) and ONLY the people listed will be allowed to pick up my child. Only prior written agreed-upon authorization will be accepted.

I understand my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Jerusalem Chapel United Brethren in Christ and any persons involved in the Awana Club ministry.

In submitting this form, I certify that the above information is correct and give permission for the use of photographs including my son/daughter to be used in church publicity.

In submitting this form, I certify that the above information is correct and give permission for the use of photographs including my son/daughter to be used in church publicity. In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached I give my permission to the Awana volunteers to secure the service of a licensed physician to provide the care necessary for my child's well-being. I assume responsibility for all costs connected to any accident or treatment of my child/children.

Please understand, we request this information because of our commitment to the safety and well-being of each child attending Jerusalem Chapel's Awana Club.