FMC Event Registration
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Email *
Registrant's First and Last Name *
Event Name *
Registrant's Street Address, City, State and Zip *
Registrant's email (if different from above)
Registrant's cell phone
Registrant's Gender
Pronoun Preference
Parent/Legal Guardian Full Name (if under 18)
Parent/Legal Guardian Cell Phone (if under 18)
Parent/Legal Guardian Email (if under 18)
Emergency Contact Name (other than parent/legal guardian already listed) *
Emergency Contact Phone *
Congregation
Priesthood Office (if any)
Housing preference (check all that apply)
Special Needs or Requests (housing, diet or other)
Consent to Medical Treatment:  As the Registrant, or if under the age of 18, the parent or legal guardian of the Registrant listed on this form, I give permission to Community of Christ to transport the Registrant to a physician or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and I will assume the responsibility for payment of all expenses and bills resulting from medical treatment. Community of Christ personnel may administer prescription medication as needed during the Event, and I agree that if the Registrant has an illness on the day the Event begins that could be harmful to him/her or to others, he/she will not be allowed to begin the Event. *
Consent to Participate in Event Activities:  As the Registrant, or as parent/guardian of the Registrant, i do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, specifically consent to the participation in all activities offered at the Event. Any activities to which I do not consent are listed in question ? above. *
Waiver and Release of Liability: In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, hereby release, forever discharge and agree to hold harmless Community of Christ and its affiliated organizations, lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees thereof from any and all damages (including consequential damages), liability, claims, judgments, penalties, obligations, fines, causes of action, demands, losses, costs, and expenses (including without limitation reasonable attorneys' fees and court costs) for personal injury, sickness or death based upon ordinary negligence, as well as property damage and expenses of any nature whatsoever which may be incurred by the parent/guardian and the Registrant occurring while Registrant is participating in the Event or arising thereafter, and further agree to hold harmless and indemnify said organizations and their lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees for any liability sustained by them as the result of the negligent, willful or intentional acts of said Registrant during the Event, including expenses incurred attendant thereto. *
Photo Release: In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older, hereby give consent to and authorize the taking of photographic, audio or video recordings in which the Registrant may appear; and hereby waive all right of privacy in and to any of said pictures or tapes and authorize the use of the recordings by Community of Christ for any and all official resource, use or purpose including but not limited to print, film, or electronic media and reproduction or digital representation of every description on the internet/world wide web. *
Event Rules: Possession of fireworks, firearms, fixed or switched blade knives (except under supervision by Event staff), any other weapons, alcohol, tobacco products, marijuana, illegal drugs or other controlled substances or their imitations are strictly forbidden, Additional Event Rules set by the Event Director are also incorporated by reference to this agreement. *
Registrant Signature: I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form. I have read, understand, and agree to abide by the Event Rules. *
Parent/Legal Guardian Signature, required if Registrant is under 18: I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form. I have read, understand, and agree to abide by the Event Rules.
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