Archery Course Registration Form

Activity Information: ("The Activity")

Name of sponsoring organization: Hibbing Alliance Church

Address: 4220 3rd Ave W, Hibbing, MN 55746 Phone: 218-262-6685

Name of sponsor's coordinator: Mark Little Elk

Description of activity: Centershot Archery League- Archery class

Date and location of activity: May 18, 12-4pm @ Hibbing Alliance Church, 4220 3rd Ave W, Hibbing MN

Student Name

First NameMiddle initialLast Name

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Phone Number

Format: (000) 000-0000.

Participant or parent E-mail

example@example.com

Name of parent(s) if Participant is a minor:

Alternate emergency contact: Name and phone number

Participant Agreement: Parent or guardian must approve participation for minors (ages 10-17).

I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant's parents or guardians if the Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emtional injury, personal injury, property damage, and financial damage.

In consideration of the opportunity to participate in the activity described above- ("The Activity"), the Participant (or parent/guardian if the participant is a minor) acknowledges and accepts risks of injury associated with participation in the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity, 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 (collectively referred to hereinafter as the "Activity Sponsor"). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor, Centershot Ministries and its coaches for any injury arising directly or indirectly out of the described Activity, whether such injury arises out of the negligence of the Activity Sponsor, Centershot Ministries, coaches, the Participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Signature of Participant and/or all parents and/or authorized guardian if participant is a minor.

Signature (fill in for multiple signatures)

Food will be served. Does the participant have food allergies? List:

Please fill out this section if the Participant is a minor. For your child's safety, will release your child to a designated person(s). Please list below any person who has permission to pick up your child after the event. If there are changes in the list prior to or during the event, you (the parent or guardian filling out this form) may update us with that information.

Centershot Archery Class May 18 12-4pm Registrants must be 10 years or older!