Richmond Hill Seventh-day Adventist® Church

Cactusville 2026

CACTUSVILLE 2026

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PARTICIPANT DETAILS

Child's Name:*

First Last

Child's Age:*

Date of Birth*

School Grade:

Street Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Telephone:

T-Shirt Size:

CRITICAL CONTACTS

Parent / Guardian's Name:*

First Last

Email Address:*

Parent / Guardian's Mobile:*

Home Church:

HEALTH HISTORY (IN CASE OF EMERGENCIES)

Please specify any known allergies or other medical conditions your child may have:*

Health Card#:

In case of emergency, primary contact*

First Last

Contact Number:*

Relationship to Child:*

In case of emergency, secondary contact (Optional)

First Last

Contact Number:

Relationship to Child

MEDICAL RELEASE FORM

I(we), the undersigned parent(s) or guardian(s) of a minor, do hereby authorize adult volunteers of Richmond Hill Seventh day Adventist Church as agent(s) for the undersigned. I further release from any liability the Richmond Hill Seventh-day Adventist Church, any of its ministries or leaders in the event of an accident en route, during and returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.

Parent / Legal Guardian (Name)*

First Last

I Agree:*

Yes

Date*

MEDIA RELEASE FORM

I understand and authorize that my child’s image may be photographed or filmed and used in video presentations, and printed publications-either digital (online) or paper publications. Any exception must be received in written form prior to the date of the event.

Parent / Legal Guardian (Name)*

First Last

I Agree:*

Yes

Date*