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Parent Contact Information

AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR:

I, the undersigned parent of the aforementioned child, a minor, do hereby authorize Word In Season Ministries as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and to be rendered under the general or special supervision of any physician or surgeon whether such diagnosis is rendered. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable.

AUTHORIZATION TO PARTICIPATE IN AWANA:

I, the undersigned parent of the aforementioned child, a minor, give permission for my child named above to join and participate in all activities related to or with the AWANA program. Permission is granted for AWANA or Word In Season Ministries staff to photograph the minor and/or myself and use the pictures for advertising or promotional use.

WAIVER OF LIABILITY:

I agree that I hereby hold harmless and waive any and all claims against Word In Season Ministries, its staff, and leaders for any accident, bodily or personal injury, damage to or loss or theft of any property, illness, or death of any person, including without limitation demands, liabilities, damages, judgments, losses, costs, expenses and/or penalties, including attorneys’ and consultants’ fee and disbursements, which arise out of joining the AWANA club at Word In Season Ministries.

Authorization

By entering my name below and submitting this form, I agree to the above.

Insurance Information

Emergency Contact Information

Online payment made after clicking Register. ($35 per student)