Nottingham Baptist Church Activity Participation Agreement
2921 Bishop Road Willoughby Hills, Ohio 44092
Activity: Vacation Bible School
Dates of Activity: June 14, 2026 - June 18, 2026
Participant Information (Submit a new form for each child)
Name of Participant
*
First Name
Last Name
Age of Participant
*
Birth Date of Participant
*
-
Month
-
Day
Year
Date
Address of Participant
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Information of Participant
Does the participant have any known allergies? If yes, please elaborate. If no, write no. Note that parent/guardian is REQUIRED to bring a snack for the participant if there is a food allergy.
*
Allergies?
Does the participant have any other known medical conditions? If yes, please elaborate. If no, write no.
*
Other medical information?
Does the participant have any dietary restrictions? If yes, please elaborate. If no, write no.
*
Diet restrictions?
Parent/Guardian and Emergency Contact Information
Name of Parent/Guardian (This individual will also serve as the primary contact in case of emergency.)
*
First Name
Last Name
Relationship to Participant
*
Phone Number of Parent/Guardian Listed Above
*
Parent/Guardian Phone
Format: (000) 000-0000.
Parent/Guardian Email (optional)
example@example.com
Emergency Contact (In the event that the parent/guardian listed above is unable to be reached.)
*
First Name
Last Name
Emergency Contact Relationship to Participant
*
Phone Number of Emergency Contact
*
Emergency Contact Phone
Format: (000) 000-0000.
Consent
Photo Release: Nottingham Baptist Church has permission to use any photos taken of the participant? (Yes or No)
*
Yes
No
Parent/Guardian Agreement
As a parent/guardian, I do herewith authorize treatment under the direction of any licensed physician of the above 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 reasonable effort has been made to contact me. I will assume responsibility of any costs connected with such treatment, and hereby release Nottingham Baptist Church from any liability.
Please read the above statement and then write your name as confirmation of full agreement with said statement.
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: