General Registration Form

Student's Name

First NameLast Name

Birth Date

MonthDayYear

Grade (if applicable)

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What are you interested in

Parent/Guardian Information

(if applying for a minor)

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

(preferably someone not previously listed on this document)

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please list and describe reactions.

Is the student prescribed an inhaler or daily medication? If yes, please explain any instructions and reason for use.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by MLee Home Decor and More x Get Crafted with MLee during the selected camp/workshop/classroom. In exchange for the acceptance of said child’s candidacy by MLee Home Decor and More x Get Crafted with MLee, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless MLee Home Decor and More x Get Crafted with MLee and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp/workshop/ classroom sessions.

In case of injury to said child, I hereby waive all claims against MLee Home Decor and More x Get Crafted with MLee including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all woodshop related activities, including sanding. Some of these injuries include, but are not limited to, the risk of cuts, burns, or death.

* Students 18 years of age is considered an adult and is responsible for his or hers care and safety while attending or participating in any MLee Home Decor and More x Get Crafted with MLee activities, programs and/or events.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the MLee Hime Decor and More x Get Crafted with MLee and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered sessions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

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.

Date

Signature

General Registration Form

Student Information