2025-26 Child/Student Registration Form

These additional individuals are authorized to pick up this child(ren) from SHBC ministries or events. (In addition to parents and the Secondary Emergency Contact)

Name*

Relationship *

Name*

Relationship *

I understand and agree that all persons picking up a child who is NOT the parent must provide a photo ID before a child is released. If another person who is NOT listed above is to pick up your child, you will let us know in writing when checking in your child. I also understand that without a parent tag, it will be necessary to present an ID before a child is released.

I AGREE*

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Are there any persons not allowed to have contact with, or pick up, your child(ren)? *** If yes, please contact Spring Hills Safety & Security Director, Marvin Rutter, to provide necessary information 740-403-1819*

YesNo

OUTDOOR PERMISSION: I am aware that weather permitting, children will be taken outside for playtime. Please dress your child(ren) accordingly (jackets, tennis shoes, sunscreen). My child(ren) have permission to be taken outside, weather permitting, for playtime on the playground and grassy areas.

I AGREE*

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PHOTOGRAPHY/VIDEO: I am aware that my child(ren) may be photographed/video taped and any photos/videos taken may be used in SHBC publications or on social media/websites. (No names will be used)

I AGREE*

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PARTICIPATION AGREEMENT: I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the 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/guardian) 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 sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.

I AGREE*

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Date

Spring Hills Baptist Church
Liability Waiver for COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and thereby unwittingly spread the disease. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death.

Spring Hills Baptist Church (SHBC) cannot prevent you from becoming exposed to, contracting, or spreading COVID-19 while participating in SHBC’s activities on and/or off the premises. It is not possible to prevent the presence of the disease-causing virus. Therefore, if you choose to participate in SHBC’s activities on and/or off SHBC’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

Waiver of Liability Relating to Coronavirus/COVID-19

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself in order to participate in SHBC’s activities on and/or off SHBC’s premises. These services are of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to participate in SHBC’s activities on and/or premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against SHBC and its officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing SHBC’s services and premises.

I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen, or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of Ohio will apply to this contract.

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

Please Print *

First NameLast Name

Signature*

Preferred Physician*

Physician Phone Number*

Preferred Dentist*

Dentist's Phone Number*

OR in the event the appropriate specified practitioner is not available, by another licenced physician or dentists:

2. The transfer of minor to preferred hospital or any hospital reasonably accessible.

Preferred Hospital*

3. This authorization does not cover major surgery unless the medical opinions of two other licensed physicans or dentists concurring in the necessity for such surgery are obtained in writing prior to the performance of such surgery.

I AGREE*

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Date

Please Print *

First NameLast Name

Signature*

2025-26: Child/Student Registration Form

1.Child/ Student

Family Preferred Contact Information

Adult Family Members

Secondary Emergency Contact Information

Additional Children/Students Participating in SHBC Activities

Permissions