REQUIRED REGISTRATION FORMS ODYSSEY WV SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR WITHIN 14 DAYS OF REGISTRATION

Size: px
Start display at page:

Download "REQUIRED REGISTRATION FORMS ODYSSEY WV SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR WITHIN 14 DAYS OF REGISTRATION"

Transcription

1 REQUIRED REGISTRATION FORMS ODYSSEY WV SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR WITHIN 14 DAYS OF REGISTRATION I understand that, during my participation on an Adventure WV program, I will be exposed to above normal risks. Although Adventure WV has taken precautions to provide proper organization, supervision, instruction and equipment for each trip, it is impossible for the Adventure WV program to guarantee absolute safety. I acknowledge that all risks cannot be eliminated without destroying the purpose and character of the trip or seminar. Also, I understand that I share the responsibility for safety on the trip and I assume that responsibility. I agree to comply with the instructions and directions of the Adventure WV staff members during the trip. The following describes some, but not all of the risks: WVU Adventure WV programs take place out of doors, where participants are subject to environmental and other risks. Activities include hiking and backpacking, camping, rock climbing, initiatives, challenge course, zip line, caving, and whitewater boating. Activities take place in remote places, far from medical facilities. Communication and transportation are difficult and sometimes evacuations and medical care can be significantly delayed. Equipment may fail or malfunction, despite reasonable maintenance and use. Meals are prepared on gas stoves or fires. Water requires disinfection before use. Camping risks and hazards include burns, cuts, diarrhea and flu-like illness, and falling timber. Travel is by vehicle, raft, on foot and by other means, over rugged unpredictable off-trail terrain, including boulder fields, downed timber, rivers, rapids, river crossings, mountain passes, steep slopes, slippery rocks. Risks include collision, falling, capsizing, drowning and others usually associated with such travel. Environmental risks and hazards include rapidly moving, deep or cold water; insects, snakes, and predators, including large animals; falling and rolling rock; lightning, flash floods, and unpredictable forces of nature, including weather which may change to extreme conditions without notice. Possible injuries and illnesses include hypothermia, frostbite, sunburn, heatstroke, dehydration, and other mild or serious conditions. I am aware that Adventure WV activities include risks of my injury or death. I understand the description above of these risks is not complete and that other unknown or unanticipated risks may result in property loss, injury or death. I agree to assume responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participant in spite of and with knowledge of the inherent risks. I have no physical or psychological problems that would prohibit my participation in the trip. I further understand that West Virginia University will not provide medical or other insurance coverage for this trip. If I must evacuate for any reason, I understand I am personally responsible for all medical/evacuation fees and that I will not receive a refund of the trip fee. (Participant must provide a copy of their medical insurance card prior to participation). In consideration for the opportunity to participate in the activity and to the extent allowed by law, I release West Virginia University and its employees, agents, and volunteers, and waive all claims for personal injury or any other damage which may arise out of or be in any way related to my participation in this activity, including any claim based on actual or alleged negligence, gross negligence, intentional, or reckless behavior. Participant s Name (Please Print): Student Signature: Date: I (we) acknowledge that there can be no guarantee of absolute safety against risks and unforeseen accident, as detailed above, that West Virginia University will not provide medical or other insurance coverage for this trip, and consent to the participation of the above named individual with the Adventure WV program. Parent/Guardian Name (If participant is under 18 yrs of age - Please print): Parent/Guardian Signature: Date: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV

2 Please write legibly and in pen. COMMITMENT TO EXCELLENCE SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR ADVENTURE WV WEST VIRGINIA UNIVERSITY COMMITMENT TO EXCELLENCE & MEDIA RELEASE FORM We are excited you are participating in an Adventure WV program. We work hard to ensure that each AWV program is safe, challenging, and fun. In order to live up to these standards and to provide the best program possible, we additionally have high expectations for all of our participants. We ask you as a participant to be committed to excellence by agreeing to abide by the course conditions, in that you will: Be open to meeting new people, try new things, have fun, and challenge yourself Be willing to do your best and work hard to complete all activities on your program Maintain a positive attitude, even in the face of hardship and difficulties Comply with procedures and practices, as outlined by the AWV staff Respect and follow the Leave No Trace environmental practices Demonstrate appropriate language and behavior toward people and the environment, and leave behind alcohol, tobacco, and/or drugs (abusive behavior or the possession of these items will be cause for expulsion). This is a tobacco-free program. I have read the above information and agree to abide by the rules and standards of Adventure WV programs. Student Signature: Date: MEDIA RECORDING/USAGE RELEASE For the privilege of participating in activities for West Virginia University, I hereby give my consent for my image and likeness to be videotaped, audiotaped, or photographed for the following uses: Educational/instructional media Recruitment/outreach media Development media Newsworthy media documentation I further authorize West Virginia University and/or West Virginia University Hospitals, Inc., and their component parts, to use this electronic media and/or photographs in any manner whole, or in part. This waiver includes usage of this media in any way deemed appropriate, which may include electronic and photographical reproductions thereof for the production of educational, instructional, promotional, or institutional advancement materials which support the educational and outreach activities of West Virginia University. I hereby waive any right I may have to inspect or approve any use of this electronic media and/or photographs and I release West Virginia University and its component parts from all liability which could result from its use. Participant s Name: Student Signature: Date: A parent or guardian must sign this form if the model is a minor or if the model is hindered by mental or physical challenges. Parent/Guardian Name: Parent/Guardian Signature: Date: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV

3 SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR ADVENTURE WV WEST VIRGINIA UNIVERSITY Participant Information Form Program Name: FIRST YEAR TRIPS ONLY: Trip Model & #: Please write legibly and in pen. Please answer the following questions honestly and accurately. This information will be kept confidential. Our goal is to provide you with the best experience possible, making accommodations where needed. Please contact us for questions or concerns about any of the following items. *Please notify us of any changes that happen between completing this form and the start of your program.* PARTICIPANT INFORMATION Last Name: First Name: WVU ID#: Height: Weight: Gender: Date of Birth: / / Age: Dorm Name & Room #: Street Address: City/State/Zip: Home Phone: Cell Phone: How did you hear about Adventure WV? EMERGENCY CONTACT INFORMATION Emergency Contact #1: Relationship: Cell Phone: Home: Work: Emergency Contact #2: Relationship: Cell Phone: Home: Work: INSURANCE INFORMATION Each participant is responsible for medical expenses. A copy of your current medical insurance card should be brought along with you on the program. Name of Insurance Company: Insurance Co. Phone: Group #: Name on Insurance Card: ALLERGY INFORMATION Do you have any ALLERGIES? YES NO If YES, do you carry epinephrine, such as an Epi-Pen? YES NO If YES, Have you ever been hospitalized for these allergies? YES NO Describe your allergies, including severity and other pertinent information: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV Page 1 of 2

4 SUBMIT THIS FORM TO OUR OFFICE BY MAIL, FAX, OR DIETARY INFORMATION Please mark dietary restrictions, needs, and requests here. If it is not listed on this form, we cannot accommodate it. Do you have any DIETARY RESTRICTIONS (i.e. vegetarian, lactose-intolerant, etc.)? YES NO Describe your dietary restrictions, including foods avoided and other pertinent information: OTHER PERTINENT HEALTH INFORMATION Please list any other pertinent health information that may affect your ability to participate in this program, including recent injuries, pre-existing health conditions, etc.: MEDICATIONS If you are taking any medication that may be required during the program, you must bring all of those with you. If you do not have them, you may not be allowed to participate in the program. Please list all medications, if not taken, that may affect your ability to participate in the program: OTHER If you regularly use any brace, orthotic, or other device, please bring this device with you. If you do not have them, you may not be allowed to participate in the program. Please list any brace, orthotic, or other device that you use regularly: VISION/HEARING CORRECTION Please bring any vision or hearing corrective items with you. If you wear contacts, please bring glasses in addition. Do you wear glasses, contacts, hearing aids, or use other implements to correct vision/hearing? YES NO PHYSICIAN INFORMATION Physician s Name: Phone: ACCURACY STATEMENT I have reviewed the AWV Essential Eligibility Criteria online at adventurefirstyear.wvu.edu/essential-eligibility-criteria and certify that I meet the criteria necessary to participate in the activities involved: (initial) I hereby state, to the best of my knowledge, my answers to the questions on this form are complete and correct. Signature of Participant: Date: Signature of Parent/Guardian (Required if under 18): Date: Phone (304) AdventureWV@mail.wvu.edu adventurewv.wvu.edu Fax (304) Rec Center Dr., Morgantown, WV Page 2 of 2

5 Note that the following four pages contain two separate thirdparty waivers, which are specific for activities associated with your Odyssey WV trip. The first waiver is a three page Rock Climbing Participant Agreement for NRocks Outdoor Adventures. While you must read over all three pages of the NRocks waiver, the ONLY page that you need to print, complete, and return to Adventure WV First-Year Trips is page 3. The second waiver is a single page Laurel Highlands River Tours, Inc. rafting waiver. You must print, complete, and return this single page waiver to Adventure WV First-Year Trips. You must return these third-party waivers in addition to the Adventure WV specific forms that precede this page.

6 Rock Climbing Participant Agreement (Including Acknowledgement of Risks and Agreements of Release and Indemnity) This document contains important information about Rock Climbing at NROCKS Outdoor Adventures and the properties on which it is located. It may affect the legal rights of participants in Rock Climbing and their families. It must be read, understood and signed by all Climbers 18 years of age or older. If a Climber is a minor (under 18 years of age) his or her parent or legal guardian (referred to herein as Parent ) must sign for himself or herself and on the behalf of the minor child. Participants under the age of 15 must be accompanied by a responsible adult (18 years or older). In consideration of being allowed to participate in Rock Climbing and to move about the adjoining properties, the undersigned adult Participant or Parent if applicable, acknowledge and agree as follows: Rock Climbing Participant understands that Rock Climbing a sport of climbing sheer rocky surfaces utilizing specialized equipment, has significant and inherent risks. Climbers will be exposed to potential falls of over 200 feet. The NROCKS Outdoor Adventures Climbing experience is designed for use by persons of at least average mobility, strength, physical ability, emotional stability, and in good health. Climber must carefully consider health issues-physical and emotional, including the use of prescription or non-prescription medications before choosing to participate, and inform NROCKS staff, in writing, prior to the beginning of the experience, of any issue which might affect his or her performance on the routes. Climber, not NROCKS staff, has the responsibility of determining his or her level of fitness and other qualifications, physical and emotional, to participate in the Climbing experience. Climber agrees that he or she will not use, and will not be under the influence of any recreational drug or alcohol while climbing the route. Climber understands that he or she must be attentive to instructions and warnings posted at the registration area and provided by NROCKS staff during the hiking and climbing portions of the experience. Failure of Climber to abide by all rules, guidelines and instructions of the Climbing staff may, at the sole discretion of the staff, result in the dismissal of Climber from the Climbing route without refund of any fee or other expense paid. Rock Climbing will expose Participant to the unpredictable forces of nature, including but not limited to, changing weather conditions, high winds, lightning and hail. Participant may come in contact with plants and insects that create hazards, including allergic reactions, and a variety of wild animals including but not limited to, deer, snakes, bear, bobcat, and skunks. Participant acknowledges that all manner of injuries may result from falling or swinging from rock faces and hitting ledges, projections, vegetation or the ground. Injuries may result from rope abrasion or entanglement during Rock Climbing activities including but not limited to climbing, belaying, rappelling, lowering on a rope, rescue systems and any other rope technique. Injuries may result from falling participants or dropped items including but not limited to ropes or climbing hardware. Damage, injuries or death may also be the result of the carelessness or negligence of spectators or other participants including belayers. Participant understands that the properties on which the Rock Climbing is located includes hilly, rocky, uneven and wooded terrain, cliffs, ravines, and creek beds. The Rock Climbing experience occurs in a remote location where radio and telephone communication is unpredictable and medical care and evacuation may be significantly delayed. Participant acknowledges that these risks are inherent in the Rock Climbing experience; that is, they cannot be eliminated without destroying the unique character of the experience. These and other risks may result in injuries and illnesses, including pinches, scrapes, twists bruises, sprains, lacerations, fractures and other physical and emotional trauma, and in extreme circumstances even death. Risks Assumption of Risks. I, adult Participant or Parent of a minor Participant, have read and understand the information above, and have viewed images and received additional information at the registration counter and/or on the web site of NROCKS Outdoor Adventures ( I understand that the above description of the risks of Rock Climbing is not complete and that these and other, including unknown or unanticipated, risks, inherent and otherwise, may result in loss of property, injury or death. If I am a Parent of a minor Participant I have discussed the activities and their risks and possible outcomes with my child, and he or she wishes to participate nevertheless. I expressly and voluntarily agree to accept and assume all of the risks of enrollment and participation in Rock Climbing and related activities, whether or not described above and inherent or otherwise. Release. I, adult Participant, or Parent of a minor Participant (Parent, for myself and, to the fullest extent allowed by law, on behalf of my minor child), hereby voluntarily release Wild West Virginia Outdoor Adventures LLC, doing business as NROCKS Outdoor Adventures, and Fun & Dreams West LLC, and their respective owners, members, officers, directors and staff ( Released Parties ) from any and all claims, demands or causes of action, which are in any way related to my, or the minor child s, enrollment

7 or participation in Rock Climbing and related activities, including the use of equipment, structures, vehicles, and premises This release includes claims of negligence of a Released Party and, to the fullest extent allowed by the laws of West Virginia, claims of gross negligence, recklessness and intentional acts of a Released Party. Indemnity. I, adult Participant or Parent of a minor Participant agree further to indemnify (that is defend and protect, and pay or reimburse) the Released Parties and each of them from any claim, by whomever it might be brought, including other Participants and members of my, or the minor child s, family, arising from my, or the child s enrollment or participation in Rock Climbing, including the use of vehicles and surrounding premises and structures. This indemnity includes losses suffered by me, or the child, and losses caused by my, or the child s, conduct. This indemnity includes claims of negligence of a Released Party and to the fullest extent allowed by the laws of West Virginia, claims of gross negligence, recklessness and intentional acts of a Released Party. Should a Released Party or anyone acting on his or her behalf incur attorney s fees and costs to enforce this agreement or otherwise defend a claim, I agree to indemnify and hold them harmless for and pay or reimburse all such fees and costs to the extent such a claim is withdrawn or relief is not granted on the claim by a court of competent jurisdiction. Other. I, adult Participant or Parent of a minor Participant, further agree: a. I have adequate insurance to cover any injury or damage I, or the minor Participant, may cause or suffer while participating in Rock Climbing or moving about the premises. b. In the event that I, the child or anyone on my or the child s behalf files a lawsuit against a Released Party, I agree that the venue of any such suit shall be Pendleton County, West Virginia. I further agree that the substantive laws of West Virginia shall apply in the action without regard to the conflict of law rules of that state. c. I have had sufficient opportunity to read this entire document. I have read and understood it and I agree to be bound by its terms. I intend it to be binding on me, members of my family, my heirs and estate. d. I hereby authorize Wild West Virginia Outdoor Adventures LLC to utilize any photo/video or any other media containing images/sounds of myself, or of my child, for promotional or other purposes, without compensation. e. If any part of this document is deemed unenforceable by a court of competent jurisdiction, the remaining provisions will nevertheless remain in full force and effect. Wild West Virginia Outdoor Adventures LLC / NROCKS Outdoor Adventures 2 Rock Climbing Participant Agreement

8 Medical Information. I, Participant (if an adult), or Parent of a minor Participant understand that participating in Rock Climbing is a strenuous activity. Obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, diabetes, asthma, allergies, seizure disorders, pregnancy, arthritis, tendonitis and other joint and muscular-skeletal problems, recent surgery and other medical issues physical and emotional (such as fear of heights) will increase the inherent risks of the experience and cause Participant to be a danger to himself or herself and to others. It is with this understanding that I have listed below my, or the minor Participant s, medical conditions pertinent to Rock Climbing. If Participant is a female, I acknowledge that participating in Rock Climbing is not recommended for women who are pregnant and that I am not, or the minor Participant is not, pregnant at this time. Participant, adult or minor, is taking the following medications: (If none, indicate none) Participant, adult or minor, has the following medical conditions which might affect his or her participation in the rock climbing activity: (If none, indicate none) I have truthfully completed the medical and special needs information called for above. NROCKS Outdoor Adventures staff is authorized to provide or obtain emergency medical care for me, or my child, and to exchange pertinent medical information with a third party medical care giver. Participant s Name (printed): Date: Adult Participant s Signature: Address: City: State: Zip: In case of emergency contact: Phone: Relation to Participant: Participant s Age (if under 18): Participant s Birth date (if under 18): If Participant is less than 18 years of age, Parent must also sign. Minor s Name (printed): Parent/Guardian Name (printed): Date: Parent/Guardian Signature: Address: City: State: Zip: Wild West Virginia Outdoor Adventures LLC / NROCKS Outdoor Adventures 3 Rock Climbing Participant Agreement

9 Form 01-5/12 LAUREL HIGHLANDS RIVER TOURS, INC. Agreement to participate and affirmation of liability release for LOWER YOUGHIOGHENY Today s Date NN - NN - NN Rally Time NN : NN Last Name nnnnnnnnnnnnnnnnnn First Name nnnnnnnnnnnnnnnnnn Present Address nnnnnnnnnnnnnnnnnn Apt. nnn City nnnnnnnnnnnnn State nn Zip nnnnn - nnnn Phone Do you want to receive specials? Yes No Is this a new address since your last visit? Yes No Date of Birth / / PARTICIPANT ASSUMES ALL RISKS. Advise us of any medical conditions that may affect your ability to participate in today s activities. In consideration of Laurel Highlands River Tours, Inc. and Laurel Highlands Rentals, Inc. ( Laurel Highlands ) furnishing services and/or equipment to enable me to participate in outdoor activities, I agree as follows: All outdoor activities by their very nature provide a physical and mental challenge to an active participant. The individual participates largely based on his or her own stamina and strength. I fully understand and acknowledge that all outdoor recreational activities, including but not limited to rafting, swimming, canoeing, hiking and bicycling, have: (a) inherent risks, dangers and hazards which exist in my use of outdoor activity equipment and my participation in outdoor activities, (b) my participation in such outdoor activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability; (c) these risk and dangers may be caused by the alleged negligence, recklessness, or gross negligence of the owners, employees, officers or agents of Laurel Highlands River Tours, Inc. and/or Laurel Highlands Rentals, Inc., including their equipment, the negligence, recklessness, or gross negligence of the participants, the negligence, recklessness, or gross negligence of others, accidents, breaches of contract, failure to render aid, the forces of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, guide decision making, including that a guide may misjudge terrain, water, weather, trail, hazards above and below the water and other hazards and dangers that are integral to recreational activities that take place in a wilderness, outdoor or recreational environment; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the alleged negligence, recklessness, or gross negligence or other conduct of the owners, agents, officers, or employees of Laurel Highlands River Tours, Inc. and/or Laurel Highlands Rentals, Inc., or by any other person. I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, forever discharge, hold harmless, defend and indemnify Laurel Highlands River Tours, Inc. and Laurel Highlands Rentals, Inc. and its owners, agents, officers, and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of any outdoor activity equipment or my participation in any outdoor activities. I specifically understand that I am forever releasing, discharging and waiving any claims or actions that I may have presently or in the future for the alleged negligent, reckless, and gross negligent acts and/or other conduct by the owners, agents, officers or employees of Laurel Highlands River Tours, Inc. and Laurel Highlands Rentals, Inc. The Venue of any dispute that may arise out of this agreement, or otherwise, between the parties to which Laurel Highlands River Tours, Inc. or Laurel Highlands Rentals, Inc. or its agents is a party, shall be either the Borough of Ohiopyle, Pennsylvania Justice Court or the State Court in Fayette County, Pennsylvania. This Agreement shall be governed by Pennsylvania law without consideration to its Choice of Law provisions. I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT, AGREE IT IS MY INTENTION TO ASSUME THE RISK OF INJURY AND RELIEVE LAUREL HIGHLANDS RIVER TOURS, INC., LAUREL HIGHLANDS RENTALS, INC., ITS AGENTS, EMPLOYEES, AND RELATED ENTITIES FROM ALL MANNER OF LIABILITY INCLUDING LIABILITY FOR PER- SONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY ANY ACTUAL OR ALLEGED NEGLIGENCE, RECKLESSNESS, GROSS NEGLIGENCE, INTENTIONAL ACT OR OMISSION, FRAUD, MISREPRESENTATION OR ANY OTHER CAUSE. Laurel Highlands River Tours, Inc. and Laurel Highlands Rentals, Inc. reserve the right to use any and all photos/videos of you or your group for promotional purposes. Signature of Participant If under the age of 18, Parent or Legal Guardian P.O. Box 107 Ohiopyle, PA RAFTIN ( ) info@laurelhighlands.com

Release and Assumption of Risk Agreement

Release and Assumption of Risk Agreement Release and Agreement Rationale & Purpose Safety is a fundamental concern of The Mountain Institute (TMI). Despite operating activities and programs to the best of our capabilities, TMI s course activities

More information

Mountain Venture Guiding (MGV) -- MVGuides.com 2460 State Route 48, Fulton, NY (315) YOUR ACKNOWLEDGMENT OF THE RISKS

Mountain Venture Guiding (MGV) -- MVGuides.com 2460 State Route 48, Fulton, NY (315) YOUR ACKNOWLEDGMENT OF THE RISKS Mountain Venture Guiding (MGV) -- MVGuides.com 2460 State Route 48, Fulton, NY 13069-4139 (315) 529-0283 Before you arrive at your outdoor event, YOU MUST thoroughly read all program materials and call

More information

REQUIRED REGISTRATION FORMS EXPLORE WV (ENGINEERING) SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR WITHIN 14 DAYS OF REGISTRATION

REQUIRED REGISTRATION FORMS EXPLORE WV (ENGINEERING) SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR  WITHIN 14 DAYS OF REGISTRATION REQUIRED REGISTRATION FORMS EXPLORE WV (ENGINEERING) SUBMIT THESE FORMS TO OUR OFFICE BY MAIL, FAX, OR EMAIL WITHIN 14 DAYS OF REGISTRATION I understand that, during my participation on an Adventure WV

More information

ALUMNI TRIP APPLICATION PACKET

ALUMNI TRIP APPLICATION PACKET ALUMNI TRIP APPLICATION PACKET THE NOLS ALUMNI TRIP APPLICATION PROCESS 1 Call the NOLS Alumni Relations Department (800.332.4280) with a non-amex credit card to supply a $200/person tuition deposit. Once

More information

West Virginia University College of Business and Economics Standards for Civility and Honor

West Virginia University College of Business and Economics Standards for Civility and Honor West Virginia University College of Business and Economics Standards for Civility and Honor Honesty, integrity, and civility are vital for a successful career. Each student given the privilege to enter

More information

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring

More information

Colorado Trek Paper Work Check List

Colorado Trek Paper Work Check List Colorado Trek Paper Work Check List Please make sure you have all your paperwork before sending it in Due June 2 - Paperwork Due June 2 - Full payment of $2400 NAME HATS Release Form Adventure Experience

More information

University of Maryland-Campus Recreation Services MAP Trip Registration Packet

University of Maryland-Campus Recreation Services MAP Trip Registration Packet University of Maryland-Campus Recreation Services MAP Trip Registration Packet Trip Name: Trip Please read the following trip information carefully. Please initial and sign where requested to acknowledge

More information

CAMPER INFORMATION SHEET RIVERS EDGE. Camper Name: Camper Birth Date: Group Attending With: Parent Name(s): Contact Address: Contact Phone:

CAMPER INFORMATION SHEET RIVERS EDGE. Camper Name: Camper Birth Date: Group Attending With: Parent Name(s): Contact Address: Contact Phone: CAMPER INFORMATION SHEET RIVERS EDGE Camper Name: Camper Birth Date: Camper Gender: M or F Group Attending With: Parent Name(s): Contact Address: Contact Phone: Contact Email: Camp Eagle 6424 Hackberry

More information

CBC CAC APP Rec d 2016 CAMP SUSQUEHANNA COUNSELOR APPLICATION Wednesday, June 22 - Sunday, June 26, 2016 (PLEASE PRINT)

CBC CAC APP Rec d 2016 CAMP SUSQUEHANNA COUNSELOR APPLICATION Wednesday, June 22 - Sunday, June 26, 2016 (PLEASE PRINT) CBC CAC APP Rec d 2016 CAMP SUSQUEHANNA COUNSELOR APPLICATION Wednesday, June 22 - Sunday, June 26, 2016 (PLEASE PRINT) New counselors and those with only one year of experience at Camp Susquehanna are

More information

REGISTRATION FORM To complete your registration please return the following to us: Registration Form (this page)

REGISTRATION FORM To complete your registration please return the following to us: Registration Form (this page) WILDERNESS FIRST RESPONDER COURSE JANUARY 2-10, 2016 REGISTRATION FORM To complete your registration please return the following to us: Registration Form (this page) Landmark Learning Release (2pgs) Payment

More information

Camp Medical Information & Release Form

Camp Medical Information & Release Form Global Youth Ministry Global Youth Camps 40 Blackhawk Trail Chatsworth, GA 30705 877-251-1800 www.globalyouthministry.org Camp Medical Information & Release Form Name Gender Age Birthdate / / Church/Org

More information

Parker Bounds Johnson Foundation Wilderness4Life & Wild Hearts Participant Waiver, Medical Info, & Consent Forms

Parker Bounds Johnson Foundation Wilderness4Life & Wild Hearts Participant Waiver, Medical Info, & Consent Forms INSTRUCTIONS: Please answer ALL portions of the documents to the best of your knowledge (check or write None if not applicable). Make sure to sign and date ALL documents, using blue or black pen ink only.

More information

Missouri Scholars Academy Medical Release Form

Missouri Scholars Academy Medical Release Form Scholar Name (First, Middle, Last) Date of Birth Parent(s)/Guardian(s) Name Address Missouri Scholars Academy Medical Release Form Home Phone Number Work Phone Number Cell Phone Number If Parent/Guardian

More information

Name Date of Birth. Do you have health/medical insurance?... no yes Name & Address of Company:

Name Date of Birth. Do you have health/medical insurance?... no yes Name & Address of Company: Health Form Disclosure Landmark programs involve a variety of activities including warm-ups, games, group initiative problems, low ropes elements and hands on application of CPR/first aid training. Some

More information

Freshman Wilderness Experience Participant Registration and Activity Contract

Freshman Wilderness Experience Participant Registration and Activity Contract Freshman Wilderness Experience Participant Registration and Activity Contract - 2019 To enroll, complete the Participant Registration and Activity Contract, the Backpacking and Camping AND/OR Canoeing

More information

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / / Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this

More information

Date of Birth Address City State Zip

Date of Birth Address City State Zip RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. You have the right to consult

More information

All expedition based on shared accommodation. If prefer single accommodations at an additional cost No Yes

All expedition based on shared accommodation. If prefer single accommodations at an additional cost No Yes MOUNTAIN LEGENDS INC ADDRESS BELLAVISTA MONTUFAR 164 TELFAX 593 9 99811941 QUITO - ECUADOR info@mountainlegendsinc.com/ www.mountainlegendsinc.com PERU EXPEDITION REGISTER FORM Name of Expedition: Full

More information

Child s Name. Home Address CO. Home/Cell Phone Sex M F Age Date of Birth. Mother or Guardian s Name Job s Address

Child s Name. Home Address CO. Home/Cell Phone Sex M F Age Date of Birth. Mother or Guardian s Name Job s Address CAMPER APPLICATION CAMP DATES: June 26 th July 1 st 2016 Volunteers of America Programs are available to any eligible person regardless of race, color, national origin, religion, sex, age, sexual orientation,

More information

CREW TREKS EXPEDITION APPLICATION - PERSONAL INFORMATION FORM

CREW TREKS EXPEDITION APPLICATION - PERSONAL INFORMATION FORM CREW TREKS EXPEDITION APPLICATION - PERSONAL INFORMATION FORM TREK/EXPEDITION: TRIP MEETING DAY: NAME: PREFERRED NAME: MAILING ADDRESS: CITY: STATE or PROVINCE: POSTAL CODE: COUNTRY: AGE: HT. WT. PHONE:

More information

Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement

Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement Name: Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement I, the undersigned individual, desire to use the U ROCK ( U ROCK s.a.l.) facilities located at Rebound

More information

After School Program Registration Form

After School Program Registration Form 2018-19 After School Program Registration Form Office Use Only Date registered: _ Staff: Please fill out this form entirely. If there are blanks it may slow down your child s enrollment process. If a line

More information

NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Albright allows Participants to participate in Participant activities that may involve or require overnight

More information

Personal Medical Record

Personal Medical Record Personal Medical Record Personal details Age: Height (in meters): Weight (in kgs): BMI (kgs/metres 2 ): *Online BMI calculation tools are easily available 1. Any previous illness - past 3 months (mention

More information

Youth Camp REGISTRATION

Youth Camp REGISTRATION Youth Camp REGISTRATION Parent #1 Name Home Phone Work Phone E-mail Address City State / ZIP Parent #2 Name Home Phone Work Phone E-mail Address City State / Zip 1. Camper s Name Age Gender Green and Gold

More information

Acknowledgment and Assumption of Risk

Acknowledgment and Assumption of Risk Acknowledgment and Assumption of Risk I acknowledge that by signing this document, I am releasing Venture Outdoors, Inc. (VO), Kayak Pittsburgh (KP), and their respective agents, employees, volunteers,

More information

A&M REC ROAD TRIP. August 28/29 Drop Off at 8:30pm at the Atrium of the Woodway Campus Pick up at 7:30 am or after Bible Study on Sunday morning.

A&M REC ROAD TRIP. August 28/29 Drop Off at 8:30pm at the Atrium of the Woodway Campus Pick up at 7:30 am or after Bible Study on Sunday morning. A&M REC ROAD TRIP 7 th and 8 th Graders of 2010 Road Trip to the Student Recreation Center at Texas A&M University August 28/29 Drop Off at 8:30pm at the Atrium of the Woodway Campus Pick up at 7:30 am

More information

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: CSU, Chico Recreational Sports Youth Camps Activity Date(s) and Time(s): Summer 2018 (June 11 August 10,

More information

Renter Agreement for Eagles Landing at Parker Creek

Renter Agreement for Eagles Landing at Parker Creek Renter Agreement for Eagles Landing at Parker Creek This Renter Agreement ("Agreement") is made and effective between The Eagles Landing and its Rental Guests regarding the property known as The Eagles

More information

Medical Release Form/Media Release Form

Medical Release Form/Media Release Form Medical Release Form/Media Release Form All participants in TCS events must have a signed Waiver & Release Form, including adults 19 years and older. Participants under 19 must have the authorized signature

More information

Outdoor Adventures. Insurance Company: Policy/Certificate # Group # Allergy List Below Reaction Medication Required

Outdoor Adventures. Insurance Company: Policy/Certificate # Group # Allergy List Below Reaction Medication Required Outdoor Adventures Participant Information Medical and Waiver Form PART 1 GENERAL INFORMATION PARTICIPANT Address: Legal Name: APT# Gender: Male Female City State Zip Cell Phone #: Z number: E-mail: EMERGENCY

More information

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it.

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it. WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT This document affects your legal rights. You should read and understand it before signing it. In consideration for receiving permission to participate in

More information

ONTARIO ELITE CIRCUIT #4

ONTARIO ELITE CIRCUIT #4 ONTARIO ELITE CIRCUIT #4 Hosted by: Newmarket Jets Speed Skating Club Newmarket ON January 26-27, 2019 REGISTRATION FORM Name #1 (new racers only) (111m track) Name #2 (new racers only) (111m track) Name

More information

Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement 3. Media Release: 4. Medical Care: 5.

Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement 3. Media Release: 4. Medical Care: 5. Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement The purpose of this Agreement is to exempt, waive, and release Released Parties from any and all liability for wrongful

More information

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer: Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,

More information

Name: Address: City/St/Zip: Phone: Grade/School: 1. Tell me about your relationship with God. How have you been growing over the past six months?

Name: Address: City/St/Zip: Phone: Grade/School: 1. Tell me about your relationship with God. How have you been growing over the past six months? LeaderTreks Trip Application Form PERSONAL INFORMATION Name: Address: City/St/Zip: Phone: Grade/School: Parents: GENERAL INFORMATION 1. Tell me about your relationship with God. How have you been growing

More information

Breckenridge Mountain Camp. Camper Information Packet

Breckenridge Mountain Camp. Camper Information Packet Breckenridge Mountain Camp Camper Information Packet 2015-2016 Please complete this packet and the Emergency Medical Information card. The accuracy of the information provided is vital in an emergency

More information

CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION

CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION Please circle the CILT program that you are interested in applying for: *Downtown *Camp Thunderbird *Chester *Chickahominy *Goochland *Midlothian *Northside

More information

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE

More information

Harleysville and Skippack, Pennsylvania

Harleysville and Skippack, Pennsylvania Volunteer Candidate Information PAWSibilities Animal Rescue Harleysville and Skippack, Pennsylvania Contact Information Name Date of Birth Street Address City ST Zip Code Home Phone Work Cell Phone Email

More information

University of Washington UWild Adventures Rental Agreement Acknowledgement of Risk & Waiver of Liability. Last: First: Items listed above are due

University of Washington UWild Adventures Rental Agreement Acknowledgement of Risk & Waiver of Liability. Last: First: Items listed above are due Last: First: Item Number Item Description Fines (Staff Use Only) Items listed above are due Date Day Time *Rental items are due by the end of regular business hours on the date noted above DEPOSIT (Must

More information

MOUNT RAINIER REGISTRATION PACKET

MOUNT RAINIER REGISTRATION PACKET MOUNT RAINIER REGISTRATION PACKET Please complete the RMI Registration Packet and return it to our office at least 90 days prior to your program date. Mail to RMI, Post Office Box Q, Ashford WA 98304 or

More information

Mail application to: Wendy Weaver 250 E. Orchard St. Delton, MI 49046

Mail application to: Wendy Weaver 250 E. Orchard St. Delton, MI 49046 This form needs to be filled out on-line and then printed, signed and mailed to Wendy Weaver at address to the right. Mail application to: Wendy Weaver 250 E. Orchard St. Delton, MI 49046 There are six

More information

New Patient Intake Paperwork

New Patient Intake Paperwork New Patient Intake Paperwork NAME: Last First Middle DATE OF BIRTH: SEX: M / F ADDRESS: Street City State Zip PHONE: MOBILE: EMAIL ADDRESS: EMPLOYER NAME: PHONE: EMPLOYER ADDRESS: EMERGENCY CONTACT: PHONE:

More information

(Student Last name, First name Middle Initial).

(Student Last name, First name Middle Initial). 2013-14 (Student Last name, First name Middle Initial). Consent for Field Trip (P1a) DHS Band Combined Form P1a, P1b, P1c I hereby consent for the above named student to participate in athletic team, band,

More information

SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM

SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM I,, am the parent and/or legal guardian of, a minor child under the age of 18 years. I would like to have my child participate in the following CAMP/PROGRAM at

More information

MAKE WELLSTON BEAUTIFUL, INC

MAKE WELLSTON BEAUTIFUL, INC MAKE WELLSTON BEAUTIFUL, INC Parks and Recreation Programs REGISTRATION FORM Please submit this form along with your completed Emergency/Release Form and Registration Fee. Make checks payable to Make Wellston

More information

Name - Mailing Address - Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone -

Name - Mailing Address -  Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone - Please take time to carefully fill out this form as it will help us to plan your trip to your satisfaction. Name - Mailing Address - Email Address - Occupation - Home Phone - Work Phone - Date of Birth

More information

Waiver, Release of Liability, Indemnification and Consent to Medical Attention

Waiver, Release of Liability, Indemnification and Consent to Medical Attention Waiver, Release of Liability, Indemnification and Consent to Medical Attention 1. Voluntary Participation. I understand and confirm that my participation in the Program is voluntary. 2. Identification

More information

2015 APPLICATION FOR MEMBERSHIP

2015 APPLICATION FOR MEMBERSHIP 2015 APPLICATION FOR MEMBERSHIP The Oregon Crusaders thanks you for your interest in being a part of the Oregon Crusaders Drum and Bugle Corps. The following information should be completed and turned

More information

DENNY PRICE FAMILY YMCA AFTERSCHOOL PROGRAM

DENNY PRICE FAMILY YMCA AFTERSCHOOL PROGRAM DENNY PRICE FAMILY YMCA AFTERSCHOOL PROGRAM REGISTRATION INFORMATION AND FORMS 2018-2019 INSPIRING ACHIEVEMENT, BELONGING AND CONNECTEDNESS Parent Information Registration Quick View REGISTRATION Complete

More information

2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA

2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA 2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA 92507 951-686-0152 Name of Participant : 2015 Mission Trip to (Location and Approximate

More information

UGA Livestock Judging Camp Athens, Georgia June 26-28, Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School:

UGA Livestock Judging Camp Athens, Georgia June 26-28, Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School: PLEASE PRINT UGA Livestock Judging Camp Athens, Georgia June 26-28, 2018 Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School: Email: Grade: Shirt Size: YS YM YL YXL AS AM AL AXL

More information

ALBION COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS

ALBION COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS ALBION COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, (or hereinafter on behalf of my minor child) ( Participant ), hereby acknowledge

More information

SO YOU RE GOING TO CAMP LIVING STONES HERE S WHAT YOU NEED TO KNOW!

SO YOU RE GOING TO CAMP LIVING STONES HERE S WHAT YOU NEED TO KNOW! SO YOU RE GOING TO CAMP LIVING STONES HERE S WHAT YOU NEED TO KNOW! NEED TO BRING: Bible, journal, and writing apparatus 2 towels and toiletries Sleeping gear (pillow, sleeping bag or blanket and sheets

More information

Blue Sky Adventure Camp - Registration Form

Blue Sky Adventure Camp - Registration Form Blue Sky Adventure Camp - Registration Form Please complete this registration form, sign it and return it with a $100 per week deposit owed for camp registration. Please note that a single registration

More information

The College of Engineering & Computer Science Webelos Engineering Pin Day Saturday, October 28, 2017

The College of Engineering & Computer Science Webelos Engineering Pin Day Saturday, October 28, 2017 The College of Engineering & Computer Science 2017 Webelos Engineering Pin Day Saturday, October 28, 2017 Registration at 7:30 a.m. - Event runs from 8:00 to 11:15 a.m. University of Evansville Koch Center

More information

Youth Camp Waiver RELEASE, WAIVER OF LIABILITY, COVENANT NOT TO SUE AND LIKENESS RELEASE

Youth Camp Waiver RELEASE, WAIVER OF LIABILITY, COVENANT NOT TO SUE AND LIKENESS RELEASE Youth Camp Waiver RELEASE, WAIVER OF LIABILITY, COVENANT NOT TO SUE AND LIKENESS RELEASE (READ CAREFULLY BEFORE SIGNING) I,, hereby acknowledge my awareness that my child s participation in the University

More information

WAIVER AND ASSUMPTION OF RISK AGREEMENT

WAIVER AND ASSUMPTION OF RISK AGREEMENT WAIVER AND ASSUMPTION OF RISK AGREEMENT Information Note This Note does not form part of the Waiver and Assumption of Risk Agreement. It is intended to give guidance about what you are agreeing to by signing

More information

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education 2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students

More information

LVC SPORTS CENTER ACTIVITIES CAMP JUNE 11 14, 2018

LVC SPORTS CENTER ACTIVITIES CAMP JUNE 11 14, 2018 LVC SPORTS CENTER ACTIVITIES CAMP JUNE 11 14, 2018 All campers will receive a 2018 camp T-shirt Lunch is served each day All campers must be dropped off and picked up at the LVC Sports Center each day

More information

Elite Athlete Strength and Conditioning Camp

Elite Athlete Strength and Conditioning Camp Elite Athlete Strength and Conditioning Camp For your child s safety, and in order to be permitted to participate in all activities, please fill out this form and return it to St. Michael s Summer Camps

More information

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF. Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,

More information

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start

More information

Physical Examination Form

Physical Examination Form Physical Examination Form Physical Examination must be completed by a licensed medical physician or nurse practitioner within twelve (12) months of camper attending camp. All campers must have this form

More information

Child: L M S XS. Session I - June Overnight Camper (9-18 years) or Day Camper (7-18 years)

Child: L M S XS. Session I - June Overnight Camper (9-18 years) or Day Camper (7-18 years) THIS APPLICATION IS FOR MANUAL REGISTRATIONS ONLY Print and mail with $100 Non Refundable deposit or full amount to: Box 870393 Tuscaloosa, AL 35487 Full Name: Preferred Name: Address: City: State: Zip:

More information

Yoga Retreat Terms and Conditions

Yoga Retreat Terms and Conditions SUNDARA DESTINATIONS, LLC Yoga Retreat Terms and Conditions Sundara Destinations, LLC ( Sundara ) is committed to providing the highest quality yoga experience for all of our guests. To help make that

More information

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado 81344 (970) 560-2926 No. LLAMA LEASE AGREEMENT Redwood Llama Company, LLC ( Lessor ) agrees to lease to the Customer named below

More information

WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM

WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM NOTE There are 5 pages of waiver forms, 4 need signatures, check the back of print outs! DUE DATE On or before June 1 st, 2019 INSTRUCTIONS

More information

Dave Spencer Ski Classic February 22-24, 2019

Dave Spencer Ski Classic February 22-24, 2019 Dave Spencer Ski Classic February 22-24, 2019 REGISTRATION FORM Registration forms, pledge sheets, and all money owed will be due Saturday, February 24. Please turn in partial pledges in advance it helps

More information

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet:

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet: Nights of Lights Youth Opti Regatta ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, 2018 Skipper s Name: DOB: Age: Boat/Fleet: Club: Sail Number: Coach Name: Coach Phone: MUST CHECK

More information

ANTEATER RECREATION SUMMER CAMP

ANTEATER RECREATION SUMMER CAMP ANTEATER RECREATION SUMMER CAMP COMPLETING YOUR WAIVER FORMS All forms have the ability to be completed through Adobe Acrobat. At this time, the University still requires inked (not electronic) signatures.

More information

COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel)

COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel) COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel) 1. I, the undersigned student desire to participate in the following activity/trip ( Activity ),

More information

HELPING PEOPLE KNOW CHRIST THROUGH HIS WORD Name of Church: City/State:

HELPING PEOPLE KNOW CHRIST THROUGH HIS WORD   Name of Church: City/State: Please note, the second page of this document must be signed and notarized. FOR OFFICE USE ONLY Code: Team: AQU BLU ORG YLW GRN HELPING PEOPLE KNOW CHRIST THROUGH HIS WORD WWW.STUDENTLIFE.COM Waiver &

More information

St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01)

St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) Please make checks payable to St. Cloud Rugby Steelhead Player Full Name: Shorts Size needed (circle one, shorts are men s sizes): Small

More information

EKU Educational Talent Search Program Student Leadership Team

EKU Educational Talent Search Program Student Leadership Team EKU Educational Talent Search Program Student Leadership Team 2018-19 Dear ETS Participant, You have indicated an interest in being on the ETS Student Leadership Team. It will be necessary for us to meet

More information

South Suburban Youth Rugby Club

South Suburban Youth Rugby Club South Suburban Youth Rugby Club Middle School Grades 4-8 High School Fresh-Soph & Varsity Registration for 2016 Spring Season ALL FORMS MUST BE COMPLETED AND TURNED IN AND DUES PAID IN FULL BEFORE A PLAYER

More information

We are excited to offer Camp Good Grief for free. This day camp is filled with fun and adventurous camp activities combined with grief support.

We are excited to offer Camp Good Grief for free. This day camp is filled with fun and adventurous camp activities combined with grief support. Dear Parent/Guardian, Thank you for interest in Hospice of Michigan's Camp Good Grief hosted at Camp Newaygo 5333 S. Centerline Rd, Newaygo, MI 49337 on Friday June 16, 2017 from 8am-4pm. We are excited

More information

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration

More information

CHINESE CULTURE CAMP REGISTRATION FORM

CHINESE CULTURE CAMP REGISTRATION FORM CHINESE CULTURE CAMP REGISTRATION FORM Child s Information: Last Name: First Name: MI: Nickname: Gender: M F Birth Date: Age: Primary Phone #: School Attending: Grade: Parent(s)/Guardian(s) Information:

More information

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of

More information

IW2K! I Want to Know! Camp April 29-30, 2016 Upham Woods Outdoor Learning Center, Wisconsin Dells, WI

IW2K! I Want to Know! Camp April 29-30, 2016 Upham Woods Outdoor Learning Center, Wisconsin Dells, WI IW2K! I Want to Know! Camp April 29-30, 2016 Upham Woods Outdoor Learning Center, Wisconsin Dells, WI REGISTRATION FORM 1. Participant Name Grade (as of 2/1/2016) 2. Address City State Zip County 3. E-mail

More information

ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT Participant s Name: Age: Date of Birth : (M) (D) (Y) Address: City: Province:

More information

Lake Washington Rowing Club

Lake Washington Rowing Club Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate

More information

SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM

SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM Personal Information Child s Name Age of Birth Parent/Legal Guardian 1 Phone Parent/Legal Guardian 2 Phone Address Alternate Phone work cell other

More information

Town of Dover Recreation Department Day Camp Registration Form

Town of Dover Recreation Department Day Camp Registration Form Town of Dover Recreation Department Day Camp Registration Form Name of Camper: Address Age Grade Entering in fall Male/Female Phone # Cell # Date of Birth (Please circle all that apply) Full Day 1. Session

More information

Welcome Aboard! This handy packet will get you prepped for your river trip Still have questions? Visit our website or give us a call

Welcome Aboard! This handy packet will get you prepped for your river trip Still have questions? Visit our website or give us a call Welcome Aboard! This handy packet will get you prepped for your river trip Still have questions? Visit our website or give us a call We look forward to rafting with you! WHAT TO WEAR Sunscreen Swimsuit,

More information

Tentative Schedule UGA Livestock Judging Camp Athens, Ga :00 am- 12:00pm Registration Double Bridges. 12:00 Orientation Double Bridges

Tentative Schedule UGA Livestock Judging Camp Athens, Ga :00 am- 12:00pm Registration Double Bridges. 12:00 Orientation Double Bridges Tentative Schedule UGA Livestock Judging Camp Athens, Ga 30605 Tuesday, June 26 10:00 am- 12:00pm Registration Double Bridges 12:00 Orientation Double Bridges 1:00pm Note Taking/Reasons Outline Indoor

More information

COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program:

COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program: COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program: THIS FORM MUST BE SIGNED AND RECEIVED BY THE CENTER FOR INTERNATIONAL EDUCATION

More information

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree: WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially

More information

AFCC CAMPER REGISTRATION FORM

AFCC CAMPER REGISTRATION FORM AFCC CAMPER REGISTRATION FORM Camper s Name Gender: M F Phone Number Email Address Address City/State/Zip Sponsor or Student Grade Completed (if student): Age Birthdate Church City T-Shirt Size: YM YL

More information

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45

More information

NE RMAI Summer Youth Camp LEADER/COUNSELOR APPLICATION PACKET

NE RMAI Summer Youth Camp LEADER/COUNSELOR APPLICATION PACKET 2018 NE RMAI Summer Youth Camp LEADER/COUNSELOR APPLICATION PACKET NE RMAI 2018 Summer Youth Camp Leader/Counselor Application Packet NOTE: RMAI 2018 Summer Youth Camp 1 will rely on the information you

More information

SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver

SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver SHANGRI LA BOTANICAL GARDENS AND NATURE CENTER 2018 EcoRangers Application, Health Form/Consent, and Liability Waiver CAMP SESSIONS AND COSTS LISTED ON PAGE 2 APPLICATION DUE DATE: JUNE 22, 2018 Application

More information

CAMP ENROLLMENT FORM

CAMP ENROLLMENT FORM CAMP ENROLLMENT FORM *This camp program is a tuition for service program, based on confirmed enrollments and secured deposits. A $35 per camper, per session non-refundable and non-transferable deposit

More information

Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall.

Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. 2018 Conservation Ecology in Ecuador/ Galapagos Islands Deposit Form Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. Upon receipt of your deposit

More information

ACADEMY DISTRICT 20 HIGH TRAILS PERMISSION FORM

ACADEMY DISTRICT 20 HIGH TRAILS PERMISSION FORM ACADEMY DISTRICT 20 HIGH TRAILS PERMISSION FORM Team Name: Middle School: Student Name: Destination: High Trails Date of Trip: Departure Time: Return Time: Mode of Transportation: ASD20 Bus Departure Location:

More information

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Camp Sessions Listed on Page 2 Application Due June 22, 2018 Application must be complete in

More information

ALASKA REGISTRATION FORM

ALASKA REGISTRATION FORM ALASKA REGISTRATION FORM Name: E-Mail: _ Trip Name: Starting Date: Number of Days: Mailing Address: Phone Number: Home: Work: Cell: Age Gender Height Weight Waist Shoe Size What are your expectations for

More information