Santee Circle COG Event/Registration Form Event Registration Form STUDENT REGISTRATION FORMName First Last Birthdate MM slash DD slash YYYY AgeParent's/ Guardian Name(s) First Last Home PhoneCell PhoneParent's Email Preferred Method of ContactCall, Text, or EmailEMERGENCY INFORMATION(who to contact in case of emergency)Emergency Contact First Last Allergies or Special Needs Add RemovePlease list any, and all allergies, special needs, and/ or medicationsDISMISSALName(Required) Name Relationship Name(Required) Name Relationship I HAVE READ AND COMPLETED THIS FORM TO THE BEST OF MY KNOWLEDGE YES NO I UNDERSTAND BY SIGNING THIS FORM THAT I RELEASE LIABILTY OF SANTEE CIRCLE COG YES NO I HAVE READ THE CONSENT AGREEMENT YES NO Consent(Required) I confirm and consent to this disclaimerDISCLAIMER Santee Circle Church of God and its leaders, directors, officers, employees, contractors, agents, volunteers, members and representatives (collectively referred to as “Santee Circle Church of God” are not responsible for any injury, loss or damage of any kind whatsoever sustained by any person or their property while participating in events, activities or travel with Santee Church of God and all related activities associated with the Church of God, including injury, loss or damage. ASSUMPTION OF RISKS IN CONSIDERATION OF Santee Circle Church of God (SCCOG) allowing me, or my child, to participate in events, activities, or travel with, and all related activities associated with the SCCOG Student Ministries (collectively referred to as the “Activities”), I acknowledge that I am aware of the possible Risks, Dangers and Hazards associated with participation in the Activities including the possible risk of severe or fatal injury to myself or others. RELEASE OF LIABILITY and AGREEMENT IN CONSIDERATION OF Santee Circle Church of God allowing me or my child to participate in the Activities, I agree on behalf of myself and/or my child: 1. TO ASSUME and ACCEPT ALL RISKS arising out of, associated with or related to my or my child’s participation in the Activities. 2. TO WAIVE and RELEASE Santee Circle Church of God from any and all liability for any loss, damage, injury or expense that I or my child may suffer, or that my next of kin may suffer as a result of my or my child’s participation in the activities due to any cause whatsoever. 3. TO INDEMNIFY and HOLD HARMLESS Santee Circle Church of God from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my or my child’s participation in the activities. 4. TO INDEMNIFY and HOLD HARMLESS Santee Circle Church of God from any and all claims, demands, actions and costs for any loss, injury, damage or expense whatsoever that might arise out of my or my child’s participation in the Activities. STUDENT PARTICPATION CONSENT Acknowledgment of Participant: I, the undersigned Participant, understand that I am responsible to act in a safe and responsible fashion, to follow the instructions or directions of the persons in charge of the Student Ministries, and to obey requests to comply with safety regulations as directed by the persons in charge of the Student Ministries, including designated leaders and drivers of private or public transportation. I will be solely responsible for myself, will wear a seatbelt when available and will not disturb or distract the driver when using private or public transportation to travel to and from Youth Group activities. At all Student Ministries sports events or other activities, I acknowledge that it is my responsibility to obtain and wear appropriate safety equipment. I will not endanger the safety of others or myself at any activities, outings or sports events of the Student Ministries or when using private or public transportation for travel to and from such activities. I also understand that I may be PHOTOGRAPHED or APPEAR in VIDEO for such purposes as SCCOG deems necessary. Acknowledgment of Parent or Guardian of Participant: We, the undersigned Parents or Guardians of the Participant, hereby authorize and consent to the Participant’s involvement in the Student Ministries, including any use of private or public transportation deemed necessary by the persons in charge of the Student Ministries for Participant travel to and from Student Ministries activities, or to the NEAREST SUITABLE MEDICAL or HOSPITAL FACILITY in the event that emergency or other medical treatment not available at the site of a Student Ministries activity is deemed advisable. We hereby consent to and authorize such emergency or other medical treatment of the Participant as may be deemed advisable in the event of accident, injury, or illness during the activities of the Student Ministries. We also understand that the participant may be PHOTOGRAPHED or APPEAR in VIDEO for such purposes as the SCCOG deems necessary. ACKNOWLEDGEMENT and SIGNATURE I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms, and I am waiving certain legal rights that my child or I may have. This Consent, Authorization and Acknowledgment shall be effective from the time of submission CAPTCHA Δ