D&D Adventures Detailed Registration Form

Participant(s) Information

Participant 1 Name

First Name Last Name

Birth Date

Month Day Year

Grade

Partcipant 2 Name

First Name Last Name

Birth Date

Month Day Year

Grade

Parent/Guardian Information

Name

First Name Last Name

Phone Number

Area Code Phone Number

E-mail

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Is there anything we should know about the participant(s) that would affect their ability to participate in an online class?

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Mages of the Mountains during the selected activity. In exchange for the acceptance of said child’s candidacy by Mages of the Mountains, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Mages of the Mountains and all its respective officers, agents, employees, and representatives from any and all liability for injuries to said child arising out of participating in selected sessions.

In case of injury to said child, I hereby waive all claims against Mages of the Mountains, including all game masters, counselors, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

D&D Adventures Activity Registration