Emergency Authorization

 

Name of Child: ____________________________________

 

In the event of emergency, representatives of Southwest Chinese Baptist Church will make effort to contact a parent or guardian. However, I hereby authorize a church representative to take immediate steps for emergency treatment for my child as named above and if necessary, transport him/her to the nearest hospital. Neither Southwest Chinese Baptist Church, nor the church representative will be liable for any medical fees incurred. In the event of any emergency (illness or accident), the following individuals may be contacted.

 

 

            Parent/Guardian’s Name                       Home Phone                              Cell phone or pager

 

 

Parent/Guardian’s Name                       Home Phone                              Cell phone or pager

 

Doctor’s Name:______________________________   Phone:_____________________________

 

Hospital:___________________________________   Phone:_____________________________

 

Insurance carrier:___________________________    Phone:_____________________________

 

List medicines to which your child is allergic to:_________________________________________

 

Waiver of Liability

I, the undersigned, will assume all risks and hazards incidental to the conduct of activities.  I hereby agree not to hold Southwest Chinese Baptist Church, its event sponsor(s), or its representatives liable for any injuries sustained by my child while on the premise of the Southwest Chinese Baptist Church, or as result of activities sponsored by the Southwest Chinese Baptist Church.

 

Acknowledgement

I, the undersigned, have read the SWCBC Awana Club Standards.  I will impress upon my child to abide by the Awana Standards.  I, or my designee, will agree to pick up my child no later than 9:30 pm.

 

 

Parent’s Signature:_____________________________  Date:___________________ 

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Conduct Agreement

While attending the Awana meetings and related activities with Southwest Chinese Baptist Church, I agree to conduct myself in a Christ-like manner and in accordance with all guidelines and regulations given by the event leader.  I understand that if my child continuously fails to follow the guidelines and rules given, the event leader will contact me and I will come and get my child at my own expense.

 

Child’s name:_____________________________  Date: _____________________

 

Parent’s signature: _________________________  Date: ­­­­­­­­­­­­­­­_____________________