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Wyldlife Registration - Zoolights
Greater Salem Young Life
greatersalemyounglife@gmail.com
503-399-7310

Email address *
Student First Name
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Parent Name *
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Student Last Name *
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Student School *
Parent Phone Number *
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Address
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Parent Email Address *
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Please note any Student Allergies or Dietary Concerns here:
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Student Phone Number
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I expressly assume any and all risks of injury or death arising from or relating to the Activities and waive and release any and all actions, claims, suits or demands of any kind or nature whatsoever against Young Life, its corporate affiliates, contractors, vendors, officer, agents, sponsors, volunteers or representatives of any kind (collectively “Releasees”) arising from or relating in any way to my voluntary participation in these activities. I understand that this Waiver, Release and Indemnification agreement means, among other things, that if I am injured or die as a result of my participation in these activities, I, and/or my family or heirs cannot under any circumstances sue Releasees or any of them for damages relating to or caused by my injuries or death.I agree to indemnify Releasees or any of them, and their subrogees, if any, in the event of any loss, damage or claim arising from or relating in any way to my participation in any of the Activities. I also hereby grant permission to Young Life the right to use, reproduce, and/or distribute photographs, films, video-tapes, and sound recordings of myself, without compensation or approval rights, for use in materials created for purposes of promoting the activities of Young Life. I have read this Waiver, Release and Indemnification Agreement, have asked and received answers to any questions I had concerning its meaning and execute it freely, without duress, and in full complete understanding of its legal effect, and of the fact that it may affect my legal rights. I am the parent or legal guardian of the child whose name appears above. *
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Electronic Signature of consenting Parent/Legal Guardian (type Full Name) *
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