CDYC Registration 2019
Middle School: June 22-25
High School: June 26-30
What's participants first name?
What's participants last name?
Please indicate male/female
What is the participant's grade?
Middle School Adult Leader
High School Adult Leader
What is the participants shirt size?
*MIDDLE SCHOOL ONLY: Which track would the participant like to do in the afternoons?
Basketball - 3 on 3 tournament, each team will compete round robin, then do a single elimination tournament
Volleyball - 6 on 6 co ed tournament, each team will participate in round robin, then do a single elimination tournament
Art - Cookies and Cavas! Students will enjoy milk and cookies from a local bakery as they are led in creating their very own painting masterpiece
Serve - We are partnering with Forgotten Children Worldwide to help sort and pack clothes that will be delivered to families in need throughout the world.
Nerf - All things nerf! you name it, we got it. there will be a couple of organized games, and some time of free play. time to get your nerf on
*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
What allergies does the participant have?
Who would the participant like to room with? (not required)
What is the parent or guardian phone number?
What is the participants cell phone number? (answer "NA" if they don't have one)
Please indicate your insurance company
Please indicate your insurance group/policy number
What medical needs does the participant have? (perscriptions, etc.) include instructions if necessary.
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. *
I do not accept
A parent signature is needed. Please indicate your affirmation of the above information and parental release by typing your name here:
Send me a copy of my responses.
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