Fall Fun Day Registration
Please register all anticipated participants, INCLUDING adults and children. You can use this form for one adult and up to 5 children for whom they are legally responsible. Additional adult participants should complete a separate form to acknowledge agreement to the liability waiver.
Email address *
Phone *
Your answer
Adult Participant First Name *
Your answer
Adult Participant Last Name: *
Your answer
Child #1 Full Name
Your answer
Child #1 Age
Child #2 Full Name
Your answer
Child #2 Age
Child #3 Full Name
Your answer
Child #3 Age
Child #4 Full Name
Your answer
Child #4 Age
Child #5 Full Name
Your answer
Child #5 Age
Liability Waiver
I acknowledge that participation in the Fall Fun Day involves risk to the Participant (and to Participant's parents or guardians, if 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 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 Western Hills Christian Church or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter 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 pursuant to the rules of the American Arbitration Association.
Acknowledgement of Liability Waiver *
Required
A copy of your responses will be emailed to the address you provided.
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