COPYRIGHT 2012 DISCOVERY CHRISTIAN CENTER

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"I applied my heart to what i observed and learned
a lesson from what i saw" - proverbs 24:32

registration form

  Parent / Guardian Contact Information (*) = Required  
  *Name   A value is required.  
  *Email   A value is required.Invalid format.  
  *Address 1   A value is required.  
  Address 2    
  *Daytime Phone   A value is required.Invalid format. Use (000)000-0000 format  
  *Evening Phone   A value is required.Invalid format.  
  Cell Phone   Invalid format.  
  *Emergency Contact Name   A value is required.  
  *Emergency Contact Phone   A value is required.Invalid format.  
         
  Student Information - Including Participating Parents
(NOTE: Parents/Guardians must remain on premises with 5 & 6 yr olds)
         
  Name(s)   Gender   Age   Birthdate   School   Grade  
        Invalid format.      
        Invalid format.      
        Invalid format.      
        Invalid format.      
        Invalid format.      
        Invalid format.      
        Invalid format.      
         
      Class Preference:      
  (Depending on Availability)
   
  READ CAREFULLY BEFORE SUBMITTING FORM!
         
  RELEASE OF LIABILITY
   
  I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Li ability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to partic ipate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or pe rsons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PE RSONS: DISCOVERY CHRISTIAN CENTER and/or their directors, officers, employees, volunteers, representatives, and agents, the activity holders, activity sponsors, activity volunteers; (B) I INDEMNIFY, HOLD HAR MLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that the DISCOVERY CHRISTIAN CENTER and th eir directors, officers, volunteers, representativ es, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of the DISCOVERY CHRISTIAN CENTER I acknowledge that this activity may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by facilities, condition of participants, equipment, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand that these activities may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by DISCOVERY CHRISTIAN CENTER and/or their producers, sponsors, organizers, and assigns. The accident waiver and release of liability shall be cons trued broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT
         
    Required I accept full liability as indicated above.  
         
  RELEASE OF LIABILITY FOR MINOR(S)
   
  PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old) I do hereby represent that I, in fact, am acting in such capacity, and have consented to my child or ward’s participation in the activity, and have agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. I further agree to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. I understand that at these activities may be photographed. I agree to allow my child or ward's photo, video, or film likeness to be used for any legitimate purpose by DISCOVERY CHRISTIAN CENTER and/or their producers, sponsors, organizers, and assigns.
         
    Required I am a parent or legal guardian and accept full liability for all minors named within this registration form as indicated above. (If no minors are included in this registration, please check anyway)  
   
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