PET Middle School Retreat 2023 Registration Form

Registration Form

PET Middle School Retreat @ John Knox Center
Are you the Group Leader?*

YesNo
Are you a member of the PET Youth Council?*

YesNo
Church Participant is Attending With*
Group Leader's Name*
Group Leader's Phone Number
Please enter a valid phone number.
Group Leader's Email *
example@example.com

John Knox Center Participant Release
Name*
Group Name*
Home Phone*
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Gender*

FemaleMaleNon-Binary
Type of Participant*
Email Address*
example@example.com
Home Street Address*
City*
Zip*
Participant's Date of Birth*
Age*
Current Grade*
Emergency Contact Person*
Phone*
Please enter a valid phone number.
I understand that I or my minor child or ward is able to physically participate in all activities that may be deemed strenuous.*

YesNo
Parent/Guardian Name*
Relationship to Child*
Mailing Address (if differs from above)
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Guardian's Email Address*
example@example.com
I hereby give my permission to the Presbytery of East Tennessee/John Knox Center for me or my minor, child or ward (collectively “minor”) to
participate in all activities and further agree to the terms herein contained. On behalf of my minor and/or myself, to partic ipate in John Knox Center
(hereinafter collectively referred to as JKC/ PET) activities and to use its equipment and facilities, I agree to release, in demnify, hold harmless, and
covenant not to sue JKC/PET, its employees, agents or volunteers for any and all liability, claims, demands, or causes of action which may be brought
by myself, my minor, or on behalf of either of us, and which are in any way connected with such use or participation by my minor or myself, whether
caused by the negligence of JKC/PET, its employees, agents, or volunteers, or otherwise. I acknowledge that myself or my minor’s participation in
individual and group initiatives, problem solving exercises, high ropes elements, and personal growth and development training activities entails known,
perceived, and unanticipated risks that could result in serious physical or emotional injury, permanent disability, or death. I understand that such risks
simply cannot be eliminated without jeopardizing the essential qualities of the activity and I expressly accept and assume on behalf of myself and/or my
minor all the risks existing in these activities.

I authorize JKC/PET personnel to call for medical care or to transport myself or my minor to a medical facility or hospital if, in the opinion of such
personnel, medical attention is needed. I agree to pay all costs associated with such medical care and transportation. I understand that every guest at
the John Knox Center site is covered by secondary insurance, with the participant’s insurance being the primary party in claims situations. I also agree
to comply JKC/PET rules and policies and to cooperate with JKC/PET personnel. I understand and agree that if myself or my minor fail to comply with
the rules and policies, s/he may be asked to leave the event at the parent or legal guardian’s expense, with no refund given for the paid cost of the
event. I hereby represent that myself and/or my minor is in good health, that I have identified all medical conditions applicable to participation, and that
I have adequately informed JKC/PET personnel of any special instructions. I certify that I have adequate insurance to cover any injury or damage my
minor or I may suffer while participating, or I agree to bear the costs of such injury or damage myself. I give my permission to allow JKC/PET to use my
likeness and/or my minor’s in photos and videos in any form of media for publicity and reporting purposes (print, digital, on line, etc.). I agree that this
release, waiver, and indemnity and other terms herein are intended to be as broad and inclusive as permitted by the law of the State of Tennessee and
if any portion is invalid, the remainder shall continue in force.

I have read the above and acknowledge the information stated on this form is complete and correct. By signing or typing my name below, I agree that
this wet inked or electronic signature is valid. I understand that an electronic signature is legally binding in Tennessee.
Signature*

Powered by Jotform Sign Clear
Date*

MonthDayYear
Date

Food Allergies/Dietary Restrictions (Mark all that Appy)

GlutenNo MeatDairyPeanuts/Tree nutsNo Animal Products of Any KindOther
If you marked other, please describe the allergy/restriction below:
Please list any physical restrictions, pre-existing conditions, or other medical concerns PET staff should be aware of.

Acknowledgement of Expectations
I aknowledge the following conditions for participating in Presbytery of East Tennesee events, and will adhere to these rules and the expectations and procedures laid out in the PET Child/Youth/Vulnerable Adult Protection Policy.

Abuse, Harrassment, and/or Bullying of any kind is prohibited. This prohibition includes any language or symbols present on clothing or accessories.

Participants cannot possess weapons of any kind during Presbytery youth events, including, but not limited to, firearms, edged weapons, bats, etc.

If a youth brings prescribed medication, that medication must be in the container with the prescription on it. Use of illegal drugs or the misuse of legal drugs is prohibited. Use of tobacco, alcohol, or vapes, by youth or adults, is prohibited.
Photo Release
Presbytery of East Tennessee will not publish any photos of participants taken during the event without the consent of the participant and their parent(s)/guardian(s). In the event that PET does publish any photos of participants, we will not publish any identifying information of participants included in the photo, such as their name or age, nor will the partipants be tagged in any PET social media posts.
*

Yes- I give consent for the Presbytery of East Tennessee to publish any pictures which include my child, under the stipulations listed above.No- I do not give my consent for the Presbytery of East Tennessee to publish any pictures which include my child, under the stipulations listed above.
Participant's Signature (if participant is a minor)*

Powered by Jotform Sign Clear
Date*

MonthDayYear
Date
Parent/Guardian or Adult Participant Signature*

Powered by Jotform Sign Clear
Date*

MonthDayYear
Date

T-shirt Size (t-shirts will come in adult sizes)*

I have read the PET Child, Youth, and Vulnerable Adult policy and made the policy available to the adult leaders attending with our group.

PET Child/Youth/Vulnerable Adult Protection Policy

As the group leader, I understand that I am responsible for collecting and holding medical/insurance information for all of the participants in my group. I will be able to provide that information to PET staff in case of emergency.

I acknowledge that all adult leaders attending with our group have been properly vetted, including a background check, and can provide receipt of background check(s) if asked.
Signature

Powered by Jotform Sign Clear
Date

MonthDayYear
Date

How Are You Paying for Registration?*

My Products

Participant RegistrationEnter description

$100.00 Quantity

PET Youth Council Registration (YOUTH COUNCIL ONLY)

$50.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Registration Form

John Knox Center Participant Release

Acknowledgement of Expectations

Photo Release