Medical Waiver

As a parent and/or guardian, I do herewith authorize treatment under the discretion of any licensed physician of the following minor in the event of a medical emergency which, in the opinion of the attending physician may endanger his or her life; cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable attempt has been made to reach me by phone listed below. The undersigned assumes the responsibility for any cost connected with such treatment and hereby releases the church where the child attends from any liability thereof.

Clubber's Information


Parent/Guardian information

Emergency Contact:

Release Signature

This release is completed and signed of my own free will with sole purpose of authorizing medical treatment under emergency circumstances in my absence. This release covers all AWANA Clubs activities and outings from September 2023 to May 2024.