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Registracion del Participante

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Pecan Grove Baptist Chuch

Location

1727 Fm Rd 359

Richmond, TX 77406

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Contact Kaylee Adams:

337-208-5408

kadams@pgbc.org

Primero, cuéntenos sobre usted:

Información de los Padres

Registration for the 2026-2027 AWANA year at PGBC is for children who will be 3 years old through 5th grade this fall. Registration is $50 per child.

Nombre

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Apellido

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Dirección 1

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Correo Electrónico

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Nombre del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Please list any adults, other than the registering parent/guardian, who are authorized to pick up your child/children.

Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Nombre alternativo de recogida 2

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Teléfono alternativo de recogida 2

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Afiliación de la iglesia local

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Cuéntanos sobre tu participante

Nombre

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Apellido

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Grado Entrando

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Género

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Fecha de nacimiento

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Preocupaciones Médicas

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Alergias

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RELEASE OF LIABILITY: I understand that Pecan Grove Baptist Church is a nonprofit charitable institution that is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground, or equipment, and that there is a resulting risk of physical injury to my child. I affirm that my child is in proper physical condition and has no existing injuries or conditions that could jeopardize his/her safety or health, or the safety or health of the other participants. I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child's participation in PGBC AWANA Program, whether or not resulting from negligence, and I agree not to sue PGBC, its representatives, staff, or volunteers on any such claim.

I have read and agree to the Release of Liability.

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Medical Release:

I give permission for the staff, representatives, or volunteers of Pecan Grove Baptist Church to administer first aid or, in the case of an emergency, to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary. I agree to reimburse PGBC for any such costs.

I have read and agree to the Medical Release.

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Photo/Video Release: I understand that I and my child may be photographed or filmed during participation in AWANA. I authorize PGBC to use those photos and videos for promotional purposes.

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Comentarios

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AWANA Registration Fee: The registration fee for PGBC AWANA is $50 per child. Payment will be collected during check in on AWANA kickoff night, September 9th, 2026.

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