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Maplesville Baptist Church
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Parent or Legal Guardian's Name (
Required
)
Parent or Guardian
Your Mailing Address
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Your Phone Number (
Required
)
Email Address (
Required
)
Child's Name (
Required
)
Emergency Contact and Phone Number
In the event of an emergency, who do we contact? Phone number?
Allergies or Medical Info
Are there any food allergies, skin allergies or respiratory allergies that your child has that might cause an emergency?
Child's Grade / Age (
Required
)
3 years
4 years
5 years (hasn't started Kindergarten)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Child's Birthday (
Required
)
January
February
March
April
May
June
July
August
September
October
November
December
Do you give permission for the child's image to appear in photographs or videos used in social media or advertisements? (
Required
)
Yes
No
I have read and agree with the Maplesville Baptist Church Awana Policy
Yes
No
Signature
By typing your name here you agree to be bound by your electronic signature.
Will this child need bus transportation?
Bus space is limited and is restricted to a certain radius from the church building. If a ride is needed, you must fill out a bus permission form also.
Yes
No
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