Date & Time
August 1, 2023 6:00 PM - 7:30 PM
Type
Price
Quantity
Medical Release (No payment)
Price
$0.00
Quantity
Medical Release + 1 Grow Group Book
Price
$8.00
Quantity
Medical Release + All 3 Grow Group Books for '23-'24 school year
Price
$20.00
Quantity
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Medical Release (No payment)
0
Have you already filled out the family information for another child?
*
Yes
No
Parent(s) Contact Info
Parent #1 Full Name
*
Parent #1 Mobile Number
*
Parent Email Address
*
Parent #2 Full Name
Parent #2 Mobile Number
Home Address
*
Home Address Line 2
Home City
*
Home State
*
Home Zip Code
*
Emergency Contact Info
Emergency Contact #1 Full Name
*
Emergency Contact #1 Mobile Phone
*
Emergency Contact #2 Full Name
*
Emergency Contact #2 Mobile Number
*
Student Info
Full Name
*
Mobile Number
Tip: If applicable
Date of Birth
*
What Grade is the Student Entering Fall 2023?
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Will the Student be in Wednesday Grow groups?
*
Not at this time
Yes - Fall 2023 (Starts in Sept.)
Yes - Winter 2024 (Starts in Jan.)
Yes - Spring 2024 (Starts late Feb.)
Would the student like to be on a Wednesday Serve Team working with Awana Sparks Every other week? (Must be in 9th-12th grade)
*
Yes
No thanks
Primary Care Physician (PCP) Full Name
*
PCP Phone Number
*
Please list any medication that your child will be taking. Please type instructions including the dosage and times per day it must be taken. (If none, N/A)
*
Drug Allergies (If none, N/A)
*
Food Allergies (If none, N/A)
*
Please list any additional info that is helpful for us to know so that we can serve your child effectively and make sure their needs are met.
*
Consents
I hereby give my consent to Maranatha Baptist Church and its leaders to obtain medical or surgical care for my (our) dependent(s) should an emergency arise in which such service is indicated.
*
Yes
No
Digital Signature - Please type the full name of the person giving consent
*
Medical Release + 1 Grow Group Book
0
Have you already filled out the family information for another child?
*
Yes
No
Parent(s) Contact Info
Parent #1 Full Name
*
Parent #1 Mobile Number
*
Parent Email Address
*
Parent #2 Full Name
Parent #2 Mobile Number
Home Address
*
Home Address Line 2
Home City
*
Home State
*
Home Zip Code
*
Emergency Contact Info
Emergency Contact #1 Full Name
*
Emergency Contact #1 Mobile Phone
*
Emergency Contact #2 Full Name
*
Emergency Contact #2 Mobile Number
*
Student Info
Full Name
*
Mobile Number
Tip: If applicable
Date of Birth
*
What Grade is the Student Entering Fall 2023?
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Will the Student be in Wednesday Grow groups?
*
Not at this time
Yes - Fall 2023 (Starts in Sept.)
Yes - Winter 2024 (Starts in Jan.)
Yes - Spring 2024 (Starts late Feb.)
Would the student like to be on a Wednesday Serve Team working with Awana Sparks Every other week? (Must be in 9th-12th grade)
*
Yes
No thanks
Primary Care Physician (PCP) Full Name
*
PCP Phone Number
*
Please list any medication that your child will be taking. Please type instructions including the dosage and times per day it must be taken. (If none, N/A)
*
Drug Allergies (If none, N/A)
*
Food Allergies (If none, N/A)
*
Please list any additional info that is helpful for us to know so that we can serve your child effectively and make sure their needs are met.
*
Consents
I hereby give my consent to Maranatha Baptist Church and its leaders to obtain medical or surgical care for my (our) dependent(s) should an emergency arise in which such service is indicated.
*
Yes
No
Digital Signature - Please type the full name of the person giving consent
*
Medical Release + All 3 Grow Group Books for '23-'24 school year
0
Have you already filled out the family information for another child?
*
Yes
No
Parent(s) Contact Info
Parent #1 Full Name
*
Parent #1 Mobile Number
*
Parent Email Address
*
Parent #2 Full Name
Parent #2 Mobile Number
Home Address
*
Home Address Line 2
Home City
*
Home State
*
Home Zip Code
*
Emergency Contact Info
Emergency Contact #1 Full Name
*
Emergency Contact #1 Mobile Phone
*
Emergency Contact #2 Full Name
*
Emergency Contact #2 Mobile Number
*
Student Info
Full Name
*
Mobile Number
Tip: If applicable
Date of Birth
*
What Grade is the Student Entering Fall 2023?
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Will the Student be in Wednesday Grow groups?
*
Not at this time
Yes - Fall 2023 (Starts in Sept.)
Yes - Winter 2024 (Starts in Jan.)
Yes - Spring 2024 (Starts late Feb.)
Would the student like to be on a Wednesday Serve Team working with Awana Sparks Every other week? (Must be in 9th-12th grade)
*
Yes
No thanks
Primary Care Physician (PCP) Full Name
*
PCP Phone Number
*
Please list any medication that your child will be taking. Please type instructions including the dosage and times per day it must be taken. (If none, N/A)
*
Drug Allergies (If none, N/A)
*
Food Allergies (If none, N/A)
*
Please list any additional info that is helpful for us to know so that we can serve your child effectively and make sure their needs are met.
*
Consents
I hereby give my consent to Maranatha Baptist Church and its leaders to obtain medical or surgical care for my (our) dependent(s) should an emergency arise in which such service is indicated.
*
Yes
No
Digital Signature - Please type the full name of the person giving consent
*
