Conquest & Challenge Halton Hills Registration Form

Member Name*

First Name Last Name

Club*

Conquest Boys ClubChallenge Girls Club

School

Grade as of September 2024 *

Home Church Parish

Member's Birth Date*

MonthDayYear

Shirt Size:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent/Guardian 1*

First NameLast Name

Phone Number*

Parent / Guardian E-mail*

Conquest and Challenge Halton Hills will use this email for weekly communication about the club events.

Parent/Guardian 2

First NameLast Name

Parent 2 Email

example@example.com

By checking this box I acknowledge that I understand that membership in Conquest & Challenge Halton Hills requires payment of an membership fee for the year to cover the club's operating costs to complete full membership.*

I understand

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the member have any allergies, regular medications, chronic illness, developmental or medical conditions? If yes, please describe.

NATURE OF ACTIVITIES:

Formation in Catholic faith and virtue combined with apostolic projects, online activities, youth mentorship and recreational activities.

ACTIVITY SUPERVISORS:

Adult and youth volunteer staff of the club/program.

PERMISSION TO PARTICIPATE IN CLUB ACTIVITIES & WAIVER OF LIABILITY AND RELEASE OF CLAIMS

In consideration of being allowed to participate in the activities organized by either Conquest or Challenge Halton Hills, I, the undersigned, hereby acknowledge and agree to the following terms and conditions.

CONSENT: I/we hereby consent to the above, named child's participation in the activites described above, specifically request that he/she be allowed to participate in those activities. I /We warrant that I/We have full authority to legally consent to my child's participation in the activites outlined in this form, and all provisions contained herein.

AUTHORIZATION: I/We hereby authorize Conquest and Challenge Halton Hills to use the image and likeness of my/our child in photograph or video form whether taken or commissioned by the club in its educaational and promotional materials and for its promotional puposes associated with its non-profit activities. This authorization shall extend to the use of my child's likeness or image on Conquest and Challenge Halton Hills website, social media or its successor in operation and affiliated organizations upon written consent of Conquest or Challenge Halton Hills. I/We understand that this authorization shall survive the end of my/our child's participation in the activities refrenced in this form.

ASSUMPTION OF RISKS: I understand that participating in a recreational sports and virtue program and related activites involves inherent risks, including but not limited to the risk of injury. I voluntarily assume all such risks and acknowledge that they are an inherent part of the activity. I understand that Conquest and Challenge Halton Hills does not carry any insurance relative to the activities for any injury that may occur to the above named child. I/We represent that the child is (a) covered by my/our own insurance carrier; or (b) that I /We am/are personally financially responsible for any and all medical costs as a result of the child's injury.

PHYSICAL CONDITION: I certify that my child is in good physical condition and have no medical conditions that would prevent my safe participation of recreational activities. I agree to inform Conquest and Challenge Halton Hills of any changes in my child's health that may affect thier ability to participate.

RULES AND GUIDELINES: I agree to abide by all rules, guidelines, and safety instructions provided by Conquest and Challenge Halton Hills and its representatives. I understand that failure to comply with these rules may result in my removal from the activity.

EMERGENCIES: If the above-named child requires any emergency medical proceedures or treatments during the activites, I /We consent tot he activitiy supervisor(s) taking, arranging for or consenting to such proceeduresor treatments at the discretionof the activity supervisor(s). I/We will make Conquest and Challenge Halton Hills aware of any allergies or medications.

RELEASE AND INDEMNIFICATION: I/We release and waive, and further agree to indemnify, hold harmless or reimburse Conquest and/or Challenge Halton Hills, the individual members, agents, directors, officiers, volunteers, and representatives thereof , as well as activity supervisors, from and against any claim which I, or any parent or guardian , any sibiling,the above-named child, or any other person , firm or corporation may have or claim to have, know or unknown, directly or indirectly, for nay losses (including attorneys' fees incurred by Conquest and Challenge Halton Hills or any of its individual agents, volunteers, etc. in enforcing this indemnity provision)without limitation in time or amount, damages or injuries arising out of, during or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any.I/We understand that this release and indemnification shall survive the end of my/our child's participation in the activities referenced in this form and shall have no limitation in time our amount.

By checking this box I acknowledge that I have read and understood the terms and conditions outlined above.*

I agree and understand

Parent/ Guardian Signature*

Signed: Parent/Guardian Name*

First NameLast Name