Workshop Registration Form

Workshop Registration

Complete form below to signup for the workshop.
Parent/Guardian First Name:*
Parent/Guardian Last Name:*
E-mail*
example@example.com
Phone Number*
Student Name*

First NameLast Name
What is the student Grade Level?
Student Name

First NameLast Name
What is the student Grade Level?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about the workshop?*

Web SiteFriend/ColleagueOnline Search
STEM Workshop:*
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STEM Workshop Registration: 50's Theme 1-Day Workshop
$55.00 Quantity

Total

$0.00
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Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Keychain Karnival LLC during the selected camp. In exchange for the acceptance of said child’s candidacy by Keychain Karnival LLC, I assume all risks and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless. In case of injury to said child, I hereby waive all claims against including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

KEYCHAIN KARNIVAL LLC

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

In exchange for using the materials contained in this kit provided by Keychain Karnival LLC, a MO limited liability company (the "Company" or "Parent"), you agree to the following:

1. You agree to read and follow the instructions included in the kit materials.

2. You assume full responsibility for personal injury to yourself or any other participant, and further waive, release, and discharge the Company, its staff, and any of its affiliates for injury, loss, or damage arising out of your use or the use by other participants, whether caused by the fault of yourself, other participants, the Company, its staff, any of its affiliates or other third parties.

3. You are aware and understand that the kit materials may involve the risk of serious injury, disability, death, and/or property damage, especially if the materials are used improperly. You acknowledge that these risks may result from or be compounded by the actions, omissions, or negligence of Company employees or others. You understand that while the Company has implemented measures to reduce the risk of injury from the Activity and the spread of the Disease, the Company cannot guarantee that you or other participants will not be injured during your usage of the kit materials.

4. You and/or other participants agree to indemnify and defend the Company, its staff, and any of its affiliates against all claims, causes of action, damages, judgments, costs, or expenses, including attorney fees and other litigation costs, which may in any way arise from your or other participants’ use of the kit materials.

5. Any legal or equitable claim that may arise from the usage of the kit materials shall be resolved under Missouri law.

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.
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