Morehead Strive for the Drive Registration
Participant:
Full Name
*
First Name
Last Name
County
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
T-shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Dietary Needs/Allergies:
*
Allergies/Health Concerns:
*
Organization
*
4-H
FFA
Novice
Adults attending with participant
Rows
Full Name
Parent, Agent,Volunteer, other
Contact Number
1
2
Emergency Contact
*
Rows
Full Name
Relationship
Contact Number
1
2
I hereby grant the Strive for the Drive program and their volunteers the right to use, reproduce, assign and/or distribute still pictures, video, and sound recordings of myself or my minor child without compensation for use in promotion, advertising, educational publications, or online content. Signature
*
As the parent/legal guardian of this participant, I acknowledge that my child is participating in this program for their personal benefit and that my child will participate in recreational and other activities as part of the program. I understand that some activities may have inherent dangers and physical risks and that no amount of care, cautions, instruction, or expertise can completely eliminate them. I assume responsibility for all risks, known and unknown, involving my child's participation in this program and I authorize's participation in reliance upon my own judgement and knowlege of my child's experience and capabilities. I hereby agree to indemnify and hold harmless the related parties from any liability, losses, costs, damages, claims, or causes of action of any kind or nature arising from or related in any way to my child's participation in this program. Signature
*
Submit
Submit
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