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This form must be signed in order to attend Ardmore Baptist Preschool.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to be spread by mainly by person to person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Ardmore Baptist Church and Preschool has put in place many preventative measures to reduce the spread of COVID-19; however, the church and preschool cannot guarantee that you or your child(ren) will not become infected with COVID-19.

Further, attending Ardmore Baptist Preschool could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Ardmore Baptist Preschool and that such exposure or infection may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by COVID-19 at preschool may result from the actions, omissions, or negligence of myself and others, including, but not limited to church/preschool employees, preschool students and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, or any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Ardmore Baptist Preschool. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Ardmore Baptist Church and Preschool, its employees, and representatives, of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the church, preschool and ministry, its employees and representatives, whether a COVID-19 infection occurs before, during, or after attendance for the 2022-2023 preschool year.

First Participants Name

First Name*

Middle Name

Last Name*

Phone*
First Participants Date of Birth*
First Participants Signature*
Second Participants Name

First Name*

Middle Name

Last Name*
Second Participants Date of Birth*
Third Participants Name

First Name*

Middle Name

Last Name*
Third Participants Date of Birth*
Fourth Participants Name

First Name*

Middle Name

Last Name*
Fourth Participants Date of Birth*
Fifth Participants Name

First Name*

Middle Name

Last Name*
Fifth Participants Date of Birth*
Sixth Participants Name

First Name*

Middle Name

Last Name*
Sixth Participants Date of Birth*
Seventh Participants Name

First Name*

Middle Name

Last Name*
Seventh Participants Date of Birth*
Eighth Participants Name

First Name*

Middle Name

Last Name*
Eighth Participants Date of Birth*
Ninth Participants Name

First Name*

Middle Name

Last Name*
Ninth Participants Date of Birth*
Tenth Participants Name

First Name*

Middle Name

Last Name*
Tenth Participants Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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