Youth Staytreat Registration
Staytreat, October 6-7. Drop off at 2 p.m. on Saturday and pick up at noon on Sunday.
Participant's Name (1 child per registration.) *
Your answer
Email *
Your answer
Parent's Full Name and Phone *
Your answer
I understand that I will have to pay $20 per child upon arrival *
Required
I understand any outside guest require pre-approval from Janice and that once approved guest must complete an online registration form. *
Emergency Contact (full name and phone number) *
Your answer
Allergies/Medical Concerns/Medications *
Your answer
Liability Waiver and Media Release
I authorize FUMC to seek emergency medical treatment at my expense should I be able to do so. *
In consideration for being accepted by Longview First United Methodist Church for participation in age-related activities, we, (I), being 18 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 18 years of age or older) do hereby release, forever discharge and agree to hold harmless Longview first United Methodist Church, its directors, staff, and volunteers from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child-participation that occur while said child is participating in any trip or activity connected with participation with Longview First United Methodist church. Furthermore, we (I) (and on behalf of our(my) child-participant if under the age of 18 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in any trip or activity connected with participation with Longview First United Methodist church. Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. The undersigned agrees to be responsible for all costs associated with the transportation, food and lodging so provided. Further, authorization and permission is hereby given by the undersigned to Longview First United Methodist Church to photograph participant and use the photographs and likenesses of participant , including but not limited to newsletters, websites, or advertising. The undersigned further herby agree to hold harmless and indemnify Longview First United Methodist Church, its directors, employees and agents, for any liability sustained by Longview First United Methodist Church as the result of the negligent, willful or intentional acts of said participants, including expenses incurred attendant thereto.(If the participant has not attained the age of 18 years):We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully. In case of medical emergency, we (I) understand every effort will be made to contact a parent or guardian. The information provided on the second page of this document regarding medical history and condition is complete and correct to the best of my knowledge. In the event we (I) cannot be reached, we (I) hereby give permission to the physician selected by Longview First United Methodist church staff, representatives, or officers, to hospitalize, secure proper treatment, and to order injection, anesthesia or surgery for my child, as named below. Further, should it be necessary for the participant to return home due to medical reason, disciplinary action or otherwise, we (I) hereby assume responsibility for all transportation costs. Only participant need sign if 18 years of age or older. If under 18, parent must sign. *
I understand that if my child does not behave in an appropriate manner I will be expected to come pick them up before the event ends. *
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