Winter Reunion Registration

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Please respond to all questions. If the question does not apply just type NA.

Email *

Registrant 1 First and Last Name *

Registrant 2 First and Last Name (spouse or partner at the same address)

Registrant's Street Address, City, State and Zip *

Registrant's email (if different from above)

Registrant 1 cell phone

Registrant 2 cell phone

Registrant 1 Gender

Registrant 2 Gender

Pronoun Preference - Registrant 1

Pronoun Preference - Registrant 2

Emergency Contact Name *

Emergency Contact Phone *

Congregation

Priesthood Office (if any) - Registrant 1

Priesthood Office (if any) - Registrant 2

Housing (check all that apply)

NOTE: Residence Center rooms will be assigned 1) to those with a medical/physical necessity, 2) to the first registration forms/payments received

I/we have a medical/physical need for the Residence Center (identify special needs in next section)

I/we can sleep in a top bunk, if necessary

I/we can sleep in a cabin, if necessary

Bringing an R/V, tent, or trailer

I/we plan to stay offsite at another location

Walk-on (please identify days you will attend in the next section)

Housing Needs Explained

Dietary Requests (please specify which registrant)

Consent to Medical Treatment: As the Registrant, or if under the age of 18, the parent or legal guardian of the Registrant listed on this form, I give permission to Community of Christ to transport the Registrant to a physician or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and I will assume the responsibility for payment of all expenses and bills resulting from medical treatment. Community of Christ personnel may administer prescription medication as needed during the Event, and I agree that if the Registrant has an illness on the day the Event begins that could be harmful to him/her or to others, he/she will not be allowed to begin the Event. *

I (we) agree

Consent to Participate in Event Activities: As the Registrant, or as parent/guardian of the Registrant, i do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, specifically consent to the participation in all activities offered at the Event. Any activities to which I do not consent are listed in question ? above. *

I (we) agree

Waiver and Release of Liability: In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, hereby release, forever discharge and agree to hold harmless Community of Christ and its affiliated organizations, lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees thereof from any and all damages (including consequential damages), liability, claims, judgments, penalties, obligations, fines, causes of action, demands, losses, costs, and expenses (including without limitation reasonable attorneys' fees and court costs) for personal injury, sickness or death based upon ordinary negligence, as well as property damage and expenses of any nature whatsoever which may be incurred by the parent/guardian and the Registrant occurring while Registrant is participating in the Event or arising thereafter, and further agree to hold harmless and indemnify said organizations and their lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees for any liability sustained by them as the result of the negligent, willful or intentional acts of said Registrant during the Event, including expenses incurred attendant thereto. *

I (we) agree

Photo Release: In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, hereby give consent to and authorize the taking of photographic, audio or video recordings in which the Registrant may appear; and hereby waive all right of privacy in and to any of said pictures or tapes and authorize the use of the recordings by Community of Christ for any and all official resource, use or purpose including but not limited to print, film, or electronic media and reproduction or digital representation of every description on the internet/world wide web. *

I (we) agree

Event Rules: Possession of fireworks, firearms, fixed or switched blade knives (except under supervision by Event staff), any other weapons, alcohol, tobacco products, marijuana, illegal drugs or other controlled substances or their imitations are strictly forbidden, Additional Event Rules set by the Event Director are also incorporated by reference to this agreement. *

I (we) agree

Registrant 1 Signature: I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form. I have read, understand, and agree to abide by the Event Rules. *

Registrant 2 Signature: I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form. I have read, understand, and agree to abide by the Event Rules.

Send me a copy of my responses.

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