The Outlet Student Registration 2024-2025

Student Registration 2024-2025

The Outlet Youth Center
Name of Student*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What grade is your student in?*
What school system does your student attend? (Rochester, Valley, Caston)*
Any known allergies:
Parent Contact*

First NameLast Name
Parent Phone Number*
Please enter a valid phone number.
Parent Email Address*
example@example.com
Relationship to Student:*
Emergency Contact Information
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Student:*
I permit for my child to ride in the van to and from The Outlet.*

YesNo
I give The Outlet staff permission to seek medical attention for, the student referenced above, should the need arise while they are at the Youth Center or participating in Youth Center activities.*

YesNo
Our staff often takes pictures and videos of our students to showcase and share our mission with our local community. This content is primarily used within The Outlet, on our Facebook and Instagram Pages, and on The Outlet's website. This content may sometimes be used in marketing collateral, such as digital advertising, service flyers, brochures, and other marketing. By marking "yes" you permit your Child's photo and/or video to be utilized by The Outlet Youth Center.*

YesNo
PLEASE NOTE!***

We have moved to TeamReach for all student/parent communication and will no longer use the Remind group! Once you submit the registration you will receive a separate email on how to join the group.
Wavier, Release, and Hold Harmless Agreement
In consideration of permission granted by The Outlet Youth Center allowing me to participate in all Outlet Youth Center sanctioned events (the Activity), which will occur between August 1st 2024 through September 1st 2025., I (together with my parent or guardian, if I am under the age of eighteen (18) or under a legal disability) represent, covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows:

1. I acknowledge that participating in the Activity involves certain risks and that bodily harm, property damage or other harm could occur to me or others. I accept and voluntarily incur all risks of any injuries, damages, or harm which arise during or result from my participation in the Activity, including any associated travel, regardless of whether or not caused in whole or in part by the negligence or other fault of The Outlet Youth Center, The Outlet Youth Center Board of Directors, and/or its or their departments, trustees, affiliates, employees, officers, agents or insurers ("Released Parties").

2. I waive all claims against any of the Released Parties for any injuries, damages, losses or claims, whether known and unknown, which arise during or result from my participation in the Activity, regardless of whether or not caused in whole or part by the negligence or other fault of any of the Released Parties. I release and forever discharge the Released Parties from all such claims.

3. I agree to indemnify and hold the Released Parties harmless from all losses, liabilities, damages, costs or expenses (including but not limited to reasonable attorneys' fees and other litigation costs and expenses) incurred by any of the Released Parties as a result of any claims or suits that I (or anyone claiming by, under or through me) may bring against any of the Released Parties to recover any losses, liabilities, costs, damages, or expenses which arise during or result from my participation in the Activity, regardless of whether or not caused in whole or part by the negligence or other fault of any of the Released Parties.
4. I have carefully read and reviewed this Waiver, Release And Hold Harmless Agreement. I understand it fully and I execute it voluntarily. Parent Signature:*

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Date Signed*

MonthDayYear
Date
Should be Empty:

Student Registration 2024-2025

Emergency Contact Information

PLEASE NOTE!***

Wavier, Release, and Hold Harmless Agreement