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I  herby authorize FSBC Westminster AWANA leaders to administer first aid; in the event of a medical emergency, if any medical or surgical care becomes becomes necessary fro any of the below named children, I grant those in charge of AWANA permission to authorize medical attention as his/her insurance coverage and/or the cost of any treatment(s) received. I understand that every effort will be made to reach me in the event of an emergency, however, I hereby authorize the bearer of theis form to act in my place and authorize emergency medical treatment should it become necessary and church officials are unable to contact me. I will not hold church personnel or volunterrs responsible if efforts to contact me are unsuccessful.

I know that FSBC Westminster, Colorado or any member of its faculty, staff, or volunteers, will in no way assume the responsibility for any injuries sustained druing participation in the AWANA program. I understand that I am signing this form electronically, and by signing it I agree to all the above and promise all information given in the below for is accurate.