New Participant Form

New Participant Form
Welcome to the Ortega Life Center, we are glad you’re joining us for one of our many programs we offer! Please fill out this form in its entirety, with up-to-date and accurate information. This form must be filled out by all participants before using the Ortega Life Center facility. This information will be kept on file to be utilized by the staff and volunteers of the facility.
Today's Date:

Month Day Year
Date
Name

First Name Last Name
DOB:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please check next to the best contact number

Home Phone: Cell Phone: Work Phone:
Phone Number

Area Code Phone Number
Gender:

Male Female
Email address:
example@example.com
This email address will be used to share opportunities, schedule adjustments, and other information related exclusively to the Ortega Life Center.
Emergency Contact Information:
In the event of an emergency, who should we contact?
Name:
Best Phone Number:
Relationship to Participant:
Please answer the following questions:
How did you hear about the Ortega Life Center?
Are you a current member of Ortega United Methodist Church?

Yes No
Have you visited Ortega Untied Methodist Church for any of the offered Sunday Services, ministry activities for children, youth, young adults, family ministry or senior ministry, community events or any other Church sponsored event?

Yes No
If Yes. which event?
Do you have a current Church home?

Yes No
Would you like to receive additional Church publications about upcoming events the Church is offering?

Yes No
Are you interested in volunteering for the Ortega Life Center?

Yes No
Please review the Ortega Life Center CODE OF CONDUCT and LIABILITY WAIVER on the following pages and proceed to sign the final page of this document.
ORTEGA LIFE CENTER
GENERAL POLICIES AND CODE OF CONDUCT
The Ortega Life Center is a part of Ortega United Methodist Church, and those participating and enjoying the activities should conduct and dress themselves accordingly. During all events, including recreation, Biblical principles will guide all behavior upon the campus.

1. The church is not responsible for lost or stolen property. Lost and found items should be turned in to the event leader.

2. Be tactful, thoughtful, helpful and Christ-like in carrying out your role as a staff, volunteer, visitor or Event Leader.

3. Activity that is contrary to the established church policy will not be permitted

4. During recreational activities, no food or drink will be allowed on the gym floor by participants or spectators.

5. Individuals are responsible for cleaning up their own mess.

6. No tobacco products, alcohol, drugs or foul language will be allowed in any area of the building or surrounding Church campus.

7. Modest dress is required at all times.

8. Foul language or unsportsman-like conduct will NOT be tolerated at any time.

9. Persistent violation of any rules could lead to the loss of personal use of the facility.

10. If for any reason a Church staff, volunteer or Event Leader feel this Code of Conduct is not being followed for any reason, you will be asked to leave the facility, only to return once the Code of Conduct is appropriately being followed.
ORTEGA LIFE CENTER
LIABILITY WAIVER / EXCULPATORY CLAUSE
Read the following very carefully, and only sign after thorough consideration and understanding.

Ortega United Methodist Church organizes and sponsors various activities within the Ortega Life Center. These activities include, but are not limited to BASKETBALL, VOLLEYBALL, PICKLE BALL, FITNESS, YOGA, TAI CHI etc.

This LIABILITY WAIVER / EXCULPATORY CLAUSE is intended to cover any and all activities, now or in the future, organized and/or promoted exclusively by Ortega United Methodist Church.

I acknowledge that the activities in which I will participate are inherently dangerous activities which may result in damages to me, my family, heirs, or assigns, in the form of monetary and/or physical injury, including but not limited to property damage, property theft, physical injury, emotional Injury and death.

In consideration of receiving permission from Ortega United Methodist Church, and/or any of its owners, officers, employees, agents and servants, contracted instructors or volunteer personnel, to participate in its activities, the receipt of such permission being hereby acknowledged, I hereby voluntarily release Ortega United Methodist Church, its owners, investors, officers, employees, agents and servants, contracted instructors or volunteer personnel on behalf of myself, and my family, heirs and assigns, of and from any and all liability, claims, demands, actions, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any property of mine, while participating in any Ortega United Methodist Church activity, or on the premises of Ortega United Methodist Church, including in route to or from Ortega United Methodist Church, or any activities organized and or promoted by Ortega United Methodist Church. It is my intent to release the above named parties from all liability for the negligence or negligent acts, whether active or passive, of any party, including but not limited to the released parties’ own negligence.

By signing this document, you have read, understand and agree to adhere to the LIABILITY WAIVER/ EXCULPATORY CLAUSE and CODE OF CONDUCT, have completed the requested information to the best of your ability, accurately and honestly, as well as acknowledge that the Ortega Life Center and/or Ortega United Methodist Church can send correspondence via electronic transmission or mail.
Participant:
(Printed Name)
(Signature)

Clear
(Date)

Month Day Year
Date
Parent/ Guardian (for participants under the age of 18)
(Printed Name)
(Signature)

Clear
(Date)

Month Day Year
Date
OFFICIAL USE ONLY Witnessed by: (OLC Staff, Instructor or Volunteer)
Should be Empty:

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New Participant Form

Emergency Contact Information:

ORTEGA LIFE CENTER

GENERAL POLICIES AND CODE OF CONDUCT

ORTEGA LIFE CENTER

LIABILITY WAIVER / EXCULPATORY CLAUSE

Participant: