CDYC Registration 2019
Middle School: June 22-25
High School: June 26-30
Email address *
What's participants first name? *
Your answer
What's participants last name? *
Your answer
Please indicate male/female *
What is the participant's grade? *
What is the participants shirt size? *
*MIDDLE SCHOOL ONLY: Which track would the participant like to do in the afternoons?
*HIGH SCHOOL ONLY: Would you like to participate in Basketball tournament? (sign up for teams at RSM)
Will the participant be performing a talent at the open mic nights? if so, please share what the talent will be *
Your answer
What allergies does the participant have? *
Your answer
Who would the participant like to room with? (not required)
Your answer
What is the parent or guardian phone number? *
Your answer
What is the participants cell phone number? (answer "NA" if they don't have one) *
Your answer
Please indicate your insurance company *
Your answer
Please indicate your insurance group/policy number *
Your answer
What medical needs does the participant have? (perscriptions, etc.) include instructions if necessary. *
Your answer
CDYC Participation Agreement: I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. * *
A parent signature is needed. Please indicate your affirmation of the above information and parental release by typing your name here: *
Your answer
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