2024 WOYC Pre Registation Form 
April 13, 2024     9:00am-12:00pm 
Please fill out the form to help us track the participation for our event.  The information gathered will only be used for counting how many participants attended and future notification of events involved with Week of the Young Child.  
We ask that all purchased food and beverages stay in the designated areas.
Photos will be taken during the event to be used for promotional purposes.  Entering the event gives us permission to use any photos taken. 
Make sure that you follow our Facebook Page: Week of the Young Child -Rockford Region
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Email *
Last name of adult guardian attending *
FIrst name of adult guardian attending    *
How many adults attending? *
How many children attending (ages birth- 8)? *
How many children attending (ages 9- 17)? *
How did you hear about the event? *
Zip code of residence  *
By submitting this form, in consideration of being permitted to participate in any way in the Week of the Young Child event,

 I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability,paralysis or death, however caused and whether caused in whole or in part by the negligence of the named below and those children that are in attendance with the said adult. 

I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the WOYC Collaboration and the  facility used by the participant,
including its owners, managers, promoters, lessees of premises used to conduct the Week of the Young Child Event or program, premises and event
inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or
loss control activities regarding the facility or events held at such facility and each of them, their directors, officers, agents,
employees, all for the purposes herein referred to as “Releasee”...FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal
representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY
CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE
PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED
IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT
FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY
SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
*
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Electronic Signature  *
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