Aviation Career Day - Student Registration
Registration Form for Aviation Career Day - St. Simons Island Airport- Saturday, March 7, 2020
This form must be completed by a Parent or Guardian in order to participate.
Parent / Legal Guardian Full Name *
Your answer
Student Participant Full Name *
Your answer
Grade *
Your answer
Email Address *
Your answer
Street Address
Your answer
(City, State, Zip Code)
Your answer
Phone Number *
Your answer
Emergency Contact Name and Relationship *
Your answer
Emergency Contact Phone Number (During Event) *
Your answer
Parental Consent & Disclosure Statement
Registration Disclosures:
Student Participant: (Listed in above form)
PARENTAL CONSENT-MUST BE SUBMITTED IN ORDER TO PARTICIPATE
In consideration of the registering student participant being allowed to participate in any way with activities related to Aviation Career Day, including, but not limited to, activities at St. Simons Island Airport, classes, commemorative photos, and/or lunch during the event; I, the parent or guardian of the above-named Student Participant, agree to the following as evidenced by my submission of this form, I also certify that I am a legally authorized parent or guardian empowered to sign this document on behalf of the above-named minor Student Participant.

MEDICAL
1. I certify that my minor child is not currently under a physician's care, is in good, health, and that I have no reason to believe that he/she is not physically, mentally, and/or emotionally capable of safely participating in the activities described on the reverse side of this Parental Consent form.
2. That should my minor child sustain injury or illness while participating in the activities described above, I hereby authorize any emergency first aid, medication or surgery deemed necessary by licensed medical personnel. I give permission for the attending medical personnel to execute on my behalf any necessary medical documents or permission forms and to act in my behalf if l am not able to do so.
3. That I understand my minor child will not be provided medical care (except on an emergency basis) for any injuries or disease occurring during the activities described above. I certify that I have sufficient medical insurance coverage to pay for any medical treatment should an injury occur. I agree to reimburse any responding medical facility or medical professional for any medical care provided.

RELEASE
1. I hereby authorize my minor child ("Student Participant") to participate in all activities during Aviation Career Day, which include, but are not limited to, all activities, classes and tours provided during the day; and lunch.
2. I assume all risks and accept all responsibility for any damages or any injury or accident that might result to Participant from his or her participation in Aviation Career Day resulting from any of Participant's own actions, inaction or negligence and/or the actions, inactions or negligence of others, or the conditions of the premises or any equipment used or other risks not known or reasonably foreseeable at this time.
3. I intend to be legally bound, and do hereby release, waive, discharge and covenant not to sue the organizers of Aviation Career Day, St. Simons Island Airport, Glynn County Board of Education, The Glynn County Airport Commission, The Brunswick and Glynn County Development Authority, Glynn County, its administrators, officers, directors, agents, coaches, teachers, instructors, non-student participants and exhibitors or other employees or volunteers, or the owners and leasers of the premises and equipment used to conduct the event, all of which are hereafter referred to as the "releasees", from any and all liability to each of the undersigned, his or her heirs, and next of kin for any claims, demands, losses or damages on account of any injury, including death and permanent or partial disability or damage to property, caused or alleged to be caused by the negligence of the releasees, excepting the sole negligence of said releasees, or otherwise in connection with and/or arising out of Student Participant's travel to, participation in, and return from the event.
4. I agree to indemnify and hold harmless the organizers of Aviation Career Day, its administrators, officers, directors, agents, teachers, instructors, non-student participants and exhibitors or other employees or volunteers, or owners or leasers of the premises and equipment used to conduct the event against all civil actions or claims for loss or damage to my property or the injury, death, disease, or disability to minor Student Participant that is caused or alleged to have been caused in whole or in part from any act having any connection with and/or arising out of Student Participant’s participation in the event.
5. My child’s information may be shared with various colleges and schools participating at the event for purposes of providing college-level information to my child and to me; colleges warrant and represent said material will be maintained in strict confidence.
6. By submitting this form I understand that I will receive the monthly Glynn County Airport Commission Newsletter.

PHOTOS
• I also specifically APPROVE photos of my minor child participating in the event to be used by news media covering the event and by the organizers in documenting and promoting the event. News organizations may use them in the print and on-line versions of their publications. Photos of my minor child participating in the event may also be posted on the official Facebook pages of this event, Civil Air Patrol, EAA, Glynn County Airport Commission, Saint Simons Island Airport, and/or other hosts and sponsors of the event.
SUBMITTING THIS FORM ENSURES I HAVE READ THE ABOVE RELEASE AND HOLD HARMLESS AGREEMENT AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS AND MADE CERTAIN IMPORTANT REPRESENTATIONS AND I HEREBY EXECUTE THE RELEASE VOLUNTARILY.


Approval of Parental Consent and Disclosures *
Required
EAA Young Eagles Flights
Launched in 1992, the Young Eagles program has dedicated more than 25 years to giving youth ages 8–17 their first free ride in an airplane.

It’s the only program of its kind, with the sole mission to introduce and inspire kids in the world of aviation.
EAA Young Eagles Registration *
Required
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