Child's Information

Date of Birth
Country
State / Province*
Address
City
Parent Email*
Confirm Email*

Guardian Information

We will send updates and reminders prior to the event, so please include the e-mail address you check most often.

Guardian #1 Name/ Relationship
Guardian #1 Cell Phone (610-xxx-xxxx)
Guardian #1 E-Mail
Guardian #2 Name/ Relationship
Guardian #2 Cell Phone (610-xxx-xxxx)
Guardian #2 E-Mail
Lives with
Emergency Contact Name/ Relationship
Emergency Phone (610-xxx-xxxx)

Medical Information

Medical Conditions
Allergies
Dietary Restrictions
Medications

Liability Waiver

I do hereby assume full responsibility for any and all damages, injuries (including death), or losses that my child may sustain or incur, if any, while attending, practicing, participating or witnessing in any club exercise program, sport or physical activity occurring in or about the club premises or at any offsite location.  I hereby assume full risk, waive all claims and release and hold B. Reed Henderson High School and the Andrew L. Hicks, Jr. Foundation, its instructors, or partners of said program or event, individually or otherwise, harmless for any and all claims for injuries or damages.

 

I am fully aware and understand that the club does not have on or about the club premises, or employ or contract with any medical services, provisions for ordinary or emergency medical services.

 

In consideration of my child’s participation in and the use of the Club’s facilities, I hereby release and covenant not to sue the Club, its owners, shareholders, directors, officers, employees, representatives, agents, and lessees from any and all claims resulting from any physical injury that may occur to my child while participating in any program or event sponsored by the Warrior Guides or the Andrew L. Hicks, Jr. Foundation.

 

I have read and fully understand the above release/waiver and fully understand that I have given up substantial rights by signing this waiver voluntarily.

 

Parent or guardians must type name as signature.

Liability Release Signature*

Photo/Video Permission

I hereby grant permission to the Andrew L. Hicks, Jr. Foundation to photograph my image and/or that of my minor child and to edit, crop, or retouch such photographs.  I consent to permit those photographs to be used by the Andrew L. Hicks, Jr. Foundation for any purpose, including education and advertisement purposes, and in any medium including print and electronic.

 

Parent or Guardian must type name as signature.

Photo Permission Signature*

IMPORTANT NOTE

ANYONE WHO REGISTERS IS EXPECTED TO ATTEND, OR CALL TO CANCEL AT LEAST ONE DAY BEFORE.

 

IF YOU DO NOT ATTEND, OR CONTACT US, YOU ARE A "NO SHOW" AND WILL NOT BE PERMITTED TO ATTEND ANOTHER OPEN EVENT THIS YEAR.

 

WE LOSE MONEY ON BUSING AND FOOD, WHEN CHILDREN REGISTER BUT DO NOT ATTEND. WE ALSO HAVE OTHER CHILDREN THAT WOULD LIKE TO ATTEND IN THAT SPOT.

 

Thank you, for your cooperation.

 

 

Please let us know if your child has any special needs (physical or behavioral). Use the comment box below.

 

An adult must ride the bus and attend the event with this child, for their comfort and safety.

 

Adults must have Child Abuse and Criminal History Clearances to attend. *These links can be found on our website under "Volunteer".

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