Cardboard Box City 2019 Participant Registration and Release of Liability
Saturday, October 5, 2019 at 4:30 p.m. to Sunday, October 6 at 7:00 a.m.
Email address *
Youth Participant Name: *
Your answer
Youth Participant Email: *
Your answer
Youth Group Name: *
Your answer
Chaperone#1 and phone number:
Your answer
Chaperone#2 and phone number:
Your answer
Parent/Guardian Emergency Contact Information
Name(s): *
Your answer
Relationship to participant: *
Your answer
Address: *
Your answer
City and Zip Code: *
Your answer
Phone Number: *
Your answer
Medical Information (please let your child's Youth Group Leader know of any concerns you have)
Allergies to medicine and food: *
Your answer
Medications being taken: *
Your answer
Doctor's Name/Phone *
Your answer
Other special medical instructions:
Your answer
I AGREE TO DEFEND, HOLD HARMLESS, AND INDEMNIFY FAMILY PROMISE OF GALLATIN VALLEY AND ANY OF ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES (COLLECTIVELY “FAMILY PROMISE”) FROM ALL LIABILITY, LOSS, OR HARM THAT MAY OCCUR BY REASON OF PARTICIPATION IN THE CARDBOARD BOX CITY EVENT. BY SIGNING BELOW, I ACKNOWLEDGE AND AGREE TO THE ABOVE, THE WAIVER AND RELEASE, AND GIVE PERMISSION FOR MEDICAL ATTENTION SET FORTH BELOW. I further give Family Promise permission to seek whatever medical attention is deemed necessary and release Family Promise of any liability against personal losses. In the event that I am injured and require the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by Family Promise, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider.
Photography/Video Release By completing this form, I grant permission for any photo images and video recordings that include my son or daughter to be used in future publicity. It is understood that there will be no compensation for this use.
Parent/Guardian Signature *
Your answer
Youth Participant Section
I have participated in Cardboard Box City before:
Youth Participant Agreement As a participant in the Cardboard Box City event, I agree to abide by the event guidelines and respect all persons and property. I understand that the consequences of inappropriate behavior may result in my being sent home from the event.
Youth Signature: *
Your answer
Parent/Guardian Signature: *
Your answer
Chaperone Agreement (if applicable)I agree that I am responsible for this youth participant in his/her parent’s or guardian’s absence. I agree to ensure their safety and know of their whereabouts throughout the event, and will ensure participant is following behavior guidelines.
Chaperone Agreement (if applicable):
Your answer
Chaperone Agreement (if applicable):
Your answer
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This form was created inside of Family Promise of Gallatin Valley.