OUC Youth Member Registration Participant Enrollment Form Program Year - September 1, 2016-August 31, 2017 A downloadable version of the form can be found at: http://orleansunitedchurch.com/youth/files/2017/04/OUC-Youth-Member-Registration-2016-2017.pdfOUC Youth MemberName* First Last Date of Birth (dd-mm-yyyy)*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Phone*Cell PhoneEmail* Enter Email Confirm Email Facebook* Already a member of OUC Youth Facebook page Do not use Facebook Please ADD me to the private OUC Youth Facebook page Parents/Guardians InformationParent Guardian Names*Parent Home Phone*Parent Cell PhoneParent Email* Enter Email Confirm Email Health InformationHealth Card NumberHealth Card Expiry Date DD MM YYYY Health ConcernsPhoto ReleasePhoto Release I, the parent/guardian of OUC Youth Member listed above, AGREE to give permission for unidentified photographs of my youth to be used on the OUC website or the OUC Youth Facebook pages. Please note that, these are public sites and therefore can be viewed by the general public. CONSENT TO PARTICIPATEThis is a legal document. By signing this document the parents/guardians and young person (the “youth” or “participant”) are giving up certain legal rights and assuming certain obligations. Notwithstanding precautions taken, accidents occur and this agreement must be signed in anticipation of that possibility. In consideration of OUC Youth Ministry and OUC Youth sponsoring or being involved with various functions with the Participant during the program year, the undersigned parents/guardians and Participant hereby: a) acknowledge that involvement in and access to some or all of these functions may involve private and/or public transportation; b) understand that these functions and transportation to and from them involve some risks; c) understand that unintended injuries and even death may possibly result as a consequence of participation in such functions and transportation to and from them; d) accept full risk and responsibility for the death of or injury to the Participant or damage to the property of the Participant arising from the functions or transportation of the Participant to and from such functions; e) release and forever discharge and waive any rights whatsoever that the undersigned and Participant may have now or in the future against Orleans United Church (“OUC”), OUC Youth, and its clergy, employees, members, Executive Director, Directors, officers, leaders, agents and volunteers as a result of death or injury to the Participant or damage to the property of the Participant arising from the participation in the functions or transportation to and from them; including all actions, causes of action, suits, claims and demands whatsoever, that may rise from any functions or transportation to and from them, however caused; f) agree to indemnify and hold harmless Orleans United Church (“OUC”) or OUC Youth and its clergy, employees, members, officers, Executive Director, Directors, leaders, agents and volunteers against any actions, suits, claims, demands whatsoever, arising, directly or indirectly, from any negligent, wrongful or illegal act or omission of the Participant in respect of any function or transportation sponsored, arranged or coordinated by OUC Youth Ministry, OUC Youth or its agents; g) agree and understand that this document will be binding on the heirs, executors, administrators and assigns of the undersigned parents/guardians and the Participant; h) agree that if any provision hereof is invalid, illegal or incapable of being enforced by reason of any rule of law or public policy then such provision will be served from and will not affect any other provision contained herein, and this instrument will be read as if such invalid, illegal or unenforceable provision had never been contained herein and all other provisions hereof will, nevertheless, remain in full force and effect and no provision will be deemed to be dependent upon any other provision; and i) agree to purchase personal insurance should they wish to protect themselves or their belongings and equipment in any way in light of the terms of this ReleaseConsentParent Consent* The undersigned acknowledges that they have read, understand and agree to the foregoing. Additionally, I authorize my Youth to attend the OUC Youth events and activities at Orleans United Church. Youth Consent* I understand that I am required to act in a safe and responsible fashion and obey requests to comply with safety regulations as directed by the OUC Youth Leaders. I will not endanger the safety of others or myself at youth events, outings and sports events. This iframe contains the logic required to handle AJAX powered Gravity Forms.