2017 CAMP ROLLER DERBY REGISTRATION
Part 1 of the Registration for Camp Roller Derby in Halibuton, Ontario August 18-20, 2017
First Name
Your answer
Last Name
Your answer
Derby Name
Your answer
Preferred Pronouns
Your answer
Home League
Your answer
I am a:
Required
Address
Your answer
City
Your answer
E-mail
Your answer
Phone
Your answer
Who would you like to bunk with?
Your answer
Please let us know of any dietary or other health needs you may have so we can do our best to accommodate.
Your answer
Chose all the topics that interest you
Have a great idea for a workshop or session or know someone great who should be there to lead it? Please let us know.
Your answer
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM for Camp Roller Derby, August 18-20, 2017 I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS EVENT, including by way of example and not limitation, any risks that may arise from negligence on the part of the persons or entities being released, from defective equipment or property owned, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit to take part in the activities of this event, and have sufficiently prepared or trained for participation in the activities of this event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Camp Eden/Camp Eden Woods/Common Sense Events and/or their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers; (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT (by clicking "accept") OF MY OWN FREE WILL. * Accept Refund and Cancellation Policy Event registrations can be transferred to another camper without penalty with a minimum of 2 weeks notice. Transfers with less than two weeks notice are subject to a $15 administrative fee. Registration cancellations must be received in writing (via email) 2 weeks (14 days) prior to the event. A refund will be issued less a $25 administrative fee. In extenuating circumstances, cancellations received less than 2 weeks before the start of the event will receive a refund minus a $45 administration fee. If for any reason the event is cancelled, registrants will receive a full refund. If for any reason an event date is changed, registrations for the original date will be honoured. In this case, refunds will be issued for cancellations without penalty, and transfers will be accepted without an administrative fee.
Required
Emergency contact, Name and number (someone who isn't going to be at Camp also)
Your answer
I would like to pay for Camp by:
Regular rate $245 ($276.85 after tax). Email $ transfers should be sent to camprollerderby@gmail.com with the password: summer2017. Details for Credit card or cheque payments will be send via an emailed invoice.
Please add $20 (tax included) to my invoice for a Camp Roller Derby t-shirt (choose a size to order)
Coupon Code
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms