Nottingham Baptist Church Activity Participation Agreement
2921 Bishop Road, Willoughby Hills, Ohio 44092
Activity: Awana
Dates of Activity: September 3, 2025 - May 6, 2026
Participant Information (Submit a new form for each child)
To be completed by authorized parent or guardian.
Name of Participant
*
First Name
Last Name
Birth Date of Participant
*
-
Month
-
Day
Year
Date
Grade of Participant
*
Please Select
PreK
K
1
2
3
4
5
6
7
8
9
10
11
12
Club
*
Please Select
Cubbies (PreK)
Sparks (Grades K-2)
T&T (Grades 3-6)
Trek (Grades 7-9)
Journey (Grades 10-12)
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 describe below. If no, please indicate no or NA.
*
Does the participant have any other known medical conditions? if yes, please describe below. If no, please indicate no or NA.
*
Does the participant have any dietary restrictions? If yes, please describe below. If no, please indicate no or NA.
*
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
*
Please enter a valid phone number.
Parent/Guardian Email (optional)
example@example.com
Would you like to receive emails from awana@nottinghambaptist.org?
*
Please Select
Yes
No
Emails sent from awana@nottinghambaptist.org include relevant information about Awana Clubs and children's programming at Nottingham Baptist Church. You may opt out of emails at anytime by emailing awana@nottinghambaptist.org.
Second Emergency Contact (In the event that the parent/guardian listed above is unable to be reached.)
*
First Name
Last Name
Second Emergency Contact Relationship to Participant
*
Second Emergency Contact Phone Number
*
Please enter a valid phone number.
Policy Agreement
I acknowledge that participation in the activity described above involves risk to the participant (and to participant's parents or guardians, if participant is a minor). In consideration for the opportunity to participate in the activity described above, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardians) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the church sponsor or its agents, employees, volunteers, or other representatives. I also acknowledge that I will not bring my child to the activity described above if that child has a fever, is under quarantine, or has been in contact with anyone having a communicable disease or infectious virus until fourteen days after exposure.
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
Do you have a home church?
Please Select
Yes
No
If yes, what is the name of your home church?
Is there any additional information you would like to share?
Submit
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