REGISTRATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

REGISTRATION

Thank you for your interest in attending the T. Alexander Foundation Breakfast Club hosted at The Mix at Arbor Place. Each student is required to complete registration prior to attending the Breakfast Club!

STUDENT

Name *

Email *

Grade *

Freshman

Sophomore

Junior

Senior

Student in the following district: *

SDOL

Manheim Township

Penn Manor

Other:

Current Grade Point Average *

After high school you plan to: *

Attend a 4 Yr Institution

Attend a Trade School or Community College

Enter the Military

Enter the Workforce

Unsure

PARENT

Name *

Email *

Phone Number *

In consideration for being permitted by the above program to participate in the above activity, I herby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which may have, or which may hereafter accrue to my child, as a result of participation in the Breakfast Club (event). This release is intended to discharge in advance the above program (its of cers, employees, volunteers, and agents), T. Alexander Foundation and The Mix at Arbor Place (program facility) from any and all liability arising out of or connected in any way with my child’s participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. *

I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of child’s death or any injury or property damage that may be sustained while participating in event.

Required

I hereby additionally consent that my son/daughter, may participate in the above activity and I hereby execute the above AGREEMENT, WAIVER, AND RELEASE on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. *

I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the above program and I complete this form in my free will.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of T. Alexander Foundation, Inc.. Report Abuse

Forms