Awana Medical Release Form

Please fill out a medical form for EACH child that will be attending our Awana program.
Gender *


Emergency Contact

Insurance information


To Whom It May Concern:

As a parent and/or guardian, I authorize the treatment by a qualified, licensed, medical professional of the following minor in the event of a medical emergency which, in the opinion of the attending phsician may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort or pain if delayed. This authority is granted only after a reasonable effort has been made to reach me.

This release form is completed and signed with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
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