Child Info



Parent/Guardian Info


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Awana Options


Wednesday Night Options*

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Medical Release Form

As the parent or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the following minor in the event of a medical emergency which in the opinion of the attending physician may endanger the life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. I also release Shandon Baptist Church, other organizations and individuals involved, of any liability for any accident incurred during the Wednesday night activities. 

This release is intended to be used during the entire year, September 2019-May 2020. This release form is completed and signed of my own will and with the sole purpose of authorizing medical treatment under emergency in my absence.

This electronic signature and its related fields are treated by Shandon Baptist Church like a handwritten signature on a paper form. I am the legal parent or guardian of this child, and I affirm that all information provided is true and correct to the best of my knowledge. Typing your name indicates that you agree the statement above and the medical release.

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