Cedar Point Trip
WMC Youth Cedar Point Trip: June 30, 2022
Youth Name
First Name
Last Name
Gender
Please Select
Female
Male
Parent/Guardian Name
First Name
Last Name
Parent Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
Please enter a valid phone number.
Parent Phone Number
Please enter a valid phone number.
Grade Completed 2021-2022 School Year
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Adult Chaperone
Insurance Information (Provider, Group Number, Policy Number)
Please list any medications/allergies/medical conditions we need to be aware of
A WMC Youth Chaperone is allowed to give my child Tylenol or Ibuprofen
Yes, Tylenol or Ibuprofen
Yes, Tylenol only
Yes, Ibuprofen only
No
Activity Participation Agreement* I acknowledge that participation in the activities of the WMC youth program may involve risk to the Participant, and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.In consideration for the opportunity to participate in these activities, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activities. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activities or during transportation to and from the activities, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives. Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the Activities planned or transportation to and from the Activities, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.
*
I agree
Payment of $50.00 is due upon Registration. Payment can be made by check to WMC and given to Alison Moore or online at Woodburnmc.org. If paying through WMC website, please select dropdown "wmcyouth" and include students name and Cedar Point. All payments must be received in full by June 8th at 9:00am. No refunds, due to the required pre-ordering of group ticket sales.
*
I agree
Parent/Guardian Signature
Submit
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