Winterfest Registration

Winterfest Registration Forms Required for EACH student.

Student's Name

First Last

Date of Birth

Student's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student's Cell Phone

Parent/Guardian's Name

First Last

Parent/Guardian's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian's Phone

Parent/Guardian's Email

Emergency Contact Name

First Last

If an emergency arises and we are unable to contact you, the parent/guardian, who can we contact as your emergency contact?

Emergency Contact Phone Number

Emergency Contact Relationship (to student)

Student's Medications

Student's Medical Insurance Information

Please also provide Student's Family Doctor information.

PLEASE READ THE FOLLOW LIABILITY RELEASE BELOW. ONCE READ PLEASE PROVIDE THE FOLLOWING STATEMENT IN THIS BOX, "I have read the liability release form and will sign my name down below."

LIABILITY RELEASE FORM Regarding Clayton Memorial Church of God Youth Group participation in (Name of trip or activity) Premiere Winterfest, Ocean City, MD January 27-29, 2023. I (on behalf of my child-participant) do hereby release, forever discharge and agree to hold harmless Clayton Memorial Church of God and the leaders thereof 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 the child-participant that occur while said child is participating in the above described trip or activity. Furthermore, I (on behalf of my child-participant) hereby assume all risk of personal injury, sickness, death, damage and expense as a result or participation in recreation and work activities involved therein. The undersigned further hereby agree to hold harmless and indemnify Clayton Memorial Church, its leaders, and employees for any liability sustained by Clayton Memorial Church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

Consent

I consent and agree to the liability release form for my student.

Signature