Big Kahuna August 22 GVE Registration and Payment

We are excited to celebrate with you at the Big Kahuna:

Saturday, August 22, 2026 4:00 PM – 7:00 PM
Floris United Methodist Church
13600 Frying Pan Road, Herndon, VA 20171

If you're registering multiple people from the same household, please complete one form per person.

Thank you!

Participant's General Information
Relationship to Participant
Name

First NameLast Name
Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type a question
Emergency Contact Relationship

Participant & Guardian Release
I agree to the following:
1. Ability to Participate. I am physically able to take part in Great Vibe Events activities.
2. Likeness Release. I give permission to Great Vibe Events to use my likeness, photo, video, name, voice, words, and biographical information to promote Great Vibe Events and raise funds for Great Vibe Events mission.
3. Risk of Injury. I know there is a risk of injury and I understand the risk of continuing to participate in active physical activities.
4. Emergency Care. If I am unable, or my guardian is unavailable, to consent or make medical decisions in an emergency, I authorize Great Vibe Events to seek medical care on my behalf.
5. Personal Information. I understand that Great Vibe Events will be collecting my personal information as part of my participation including my name, image, address, telephone number. I agree and consent to Great Vibe Events using my contact information for communicating with me about Great Vibe Events.
In consideration of being allowed to participate in any way in Great Vibe Events, competition or fundraising activities, the undersigned acknowledges, appreciates, and agrees that:
1. Participation includes possible exposure to and illness from infectious and/or communicable diseases including but not limited to MRSA, influenza, and COVID-19. While rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Great Vibe Events, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name of Participant

First NameLast Name
Participant Signature
Date Signed

MonthDayYear
Date
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
Name of Parent/Guardian

First NameLast Name
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
I have completed my form and am ready to check out

My Products
Categories:All

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prevnext( X )
Participant
Registration fee for one person

$45.00 Quantity
Item subtotal:$0.00

Caregiver Meal
Dinner Ticket for Caregiver attending with participant

$15.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Should be Empty:

Great Vibes Registration Form

Participant's Health History

Participant's General Information

Emergency Contact

Participant & Guardian Release

My Products

Payment Methods