CM Wonder of Winter Wildlife Holiday Participation Policy and Photo Consent

RSVP, Waiver, & Participation Policy: The "Wonder of Winter Wildlife"

CONFIRMACIÓN DE ASISTENCIA y Política de Participación: La «Maravilla de la Fauna Invernal» en Toby Wells YMCA
OUR EVENT IS NOW CLOSED AND AT FULL CAPACITY! ¡NUESTRO EVENTO YA ESTÁ CERRADO Y CON CAPACIDAD COMPLETA!
A CAMP COSMOS PROGRAM: SUNDAY, DECEMBER 15, 2024, 10:30AM-1:30 PM

UN PROGRAMA DE CAMP COSMOS DOMINGO 15 DE DICIEMBRE DE 2024, DE 10:30 A 13:30 HORAS
Online and/or in-person event?

My child would like to participate in this online event! (Sí, a mi hijo le gustaría participar en este acto en línea!)My child would like to participate in this in-person event! (Sí, a mi hijo le gustaría participar en este acto presencial!)My child would like to participate in both in-person and online event! (A mi hijo le gustaría participar tanto en el evento presencial como en el evento en línea!)
Primary participating child's name (Nombre del niño participante)

First Name (Nombre)Last Name (Apellido)
Please enter the TOTAL NUMBER of family members attending (including the primary participating child). Indique el NÚMERO TOTAL de miembros de la familia que asistirán (incluido el hijo principal participante).
Of this total number, how many (including the primary participating child) are under the age of 18? Please let us know their ages? (ex - Jennifer, age 8, Thomas, age 12) De este número total, ¿cuántos (incluido el hijo principal participante) son menores de 18 años? Por favor, indíquenos sus edades. (ex - Jennifer, 8 años, Thomas, 12 años)
Parent Name (Nombre del padre o de la madre)

First Name (Nombre)Last Name (Apellido)
Parent email (Correo electrónico de los padres)
example@example.com
I grant to ConnectMed the right and permission to use the images (on still and/or video footage) of myself and my child(ren), either alone or accompanied by other material, for promotional material, educational activities, or any other lawful purpose whatsoever. (Concedo a ConnectMed el derecho y el permiso de utilizar las imágenes (en imágenes fijas y/o en vídeo) mías y de mi(s) hijo(s), solas o acompañadas de otro material, para material promocional, actividades educativas o cualquier otro fin lícito.)

Yes, I grant permission (Sí, concedo permiso)No, please no photos (Por favor, no fotos)
Cell Phone Number (Número de móvil)
Please enter a valid phone number. (Introduzca un número de teléfono válido.)
Signature (Firma)

Powered by Jotform SignClear
I certify that I am the parent or guardian of the above named child(ren).

I understand that ConnectMed is a non-profit organization which provides its Camp Cosmos programs and activities, including the December 15th, 2024 at Toby Wells, at no cost to participating families.

By signing this agreement, I commit to having the total number of family members specified above, including the named child, join Camp Cosmos on December 15th, from 10:30am - 1:30pm.

**I understand that, unless I email or call ConnectMed by December 13th by NOON to withdraw my registration, ConnectMed has the right to invoice me a $20/family member fee to activity/material fees. **

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Certifico que soy el padre, la madre o el tutor del/de los niño(s) arriba mencionado(s).

Entiendo que ConnectMed es una organización sin ánimo de lucro que proporciona sus programas y actividades de Camp Cosmos, incluyendo el 15 de diciembre de 2024 en Toby Wells, sin coste alguno para las familias participantes.

Al firmar este acuerdo, me comprometo a que el número total de miembros de la familia especificados anteriormente, incluido el niño mencionado, se unan a Camp Cosmos el 15 de diciembre, de 10:30 a 13:30.

**Entiendo que, a menos que envíe un correo electrónico o llame a ConnectMed antes del 13 de diciembre al MEDIODÍA para retirar mi inscripción, ConnectMed tiene derecho a facturarme una cuota de $20/miembro de la familia a los honorarios de la actividad/material.**
I authorize ConnectMed to text me at the number above for reminders and information about the event. (Autorizo a ConnectMed a enviarme mensajes de texto al número indicado para recordatorios e información sobre el evento.)

Yes, you can text (Sí, puede enviar mensajes de texto)No, I will receive information by email only. (No, sólo recibiré información por correo electrónico.)
Please let us know more about your family...

If you have pre-registered, feel free to skip these...
Any accessibility requirements?
Please describe medical diagnosis and any allergies related to your child.
Is there anything else we can learn about your child that can help us provide a positive experience for your family?
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RSVP, Waiver, & Participation Policy: The "Wonder of Winter Wildlife"

OUR EVENT IS NOW CLOSED AND AT FULL CAPACITY! ¡NUESTRO EVENTO YA ESTÁ CERRADO Y CON CAPACIDAD COMPLETA!

A CAMP COSMOS PROGRAM: SUNDAY, DECEMBER 15, 2024, 10:30AM-1:30 PM

I certify that I am the parent or guardian of the above named child(ren).

I understand that ConnectMed is a non-profit organization which provides its Camp Cosmos programs and activities, including the December 15th, 2024 at Toby Wells, at no cost to participating families.

By signing this agreement, I commit to having the total number of family members specified above, including the named child, join Camp Cosmos on December 15th, from 10:30am - 1:30pm.

**I understand that, unless I email or call ConnectMed by December 13th by NOON to withdraw my registration, ConnectMed has the right to invoice me a $20/family member fee to activity/material fees. **

Please let us know more about your family...

I understand that, unless I email or call ConnectMed by December 13th by NOON to withdraw my registration, ConnectMed has the right to invoice me a $20/family member fee to activity/material fees.