Tres Dias Registration Form
CANDIDATE - PARTICIPANT
Today's Date
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1. Full Name
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First Name
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1. Phone Number
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Format: (000) 000-0000.
1. Email
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1. Your Location
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1. Date of Birth
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1. Gender
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1. T-Shirt Size
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1. Age
1. Name of your Home Church:
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For all additional participants who are 15 years old and older - please choose Adult option.
1. Additional Participant
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None
Adult Candidate
Junior Candidate (12-16 yo)
Child
1. Sub-Total Amount Due
2. Relationship
*
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Spouse
Child
Relative
Friend
Other
2. Name
*
First Name
Last Name
2. Date of Birth
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Month
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Day
Year
Date
2. Age
2. Gender
*
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Male
Female
2. T-Shirt Size
*
Please Select
S
M
L
XL
XXL
2. Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
2. Email
*
example@example.com
2. Additional Participants
*
Please Select
None
Adult Candidate
Junior Candidate (12-16 yo)
Child
2. Sub-Total Amount Due
3. Relationship
*
Please Select
Spouse
Child
Relative
Friend
Other
3. Name
*
First Name
Last Name
3. Date of Birth
*
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Month
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Day
Year
Date
3. Age
3. Gender
*
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Male
Female
3. T-Shirt Size
*
Please Select
S
M
L
XL
XXL
3. Additional Participants
*
Please Select
None
Adult Candidate
Junior Candidate (12-16 yo)
Child
3. Sub-Total Amount Due
4. Relationship
*
Please Select
Spouse
Child
Relative
Friend
Other
4. Name
*
First Name
Last Name
4. Date of Birth
*
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Day
Year
Date
4. Age
4. Gender
*
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Male
Female
4. T-Shirt Size
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S
M
L
XL
XXL
4. Additional Participants
*
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None
Adult Candidate
Junior Candidate (12-16 yo)
Child
4. Sub-Total Amount Due
5. Relationship
*
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Spouse
Child
Relative
Friend
Other
5. Name
*
First Name
Last Name
5. Date of Birth
*
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Month
-
Day
Year
Date
5. Age
5. Gender
*
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Male
Female
5. T-Shirt Size
*
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S
M
L
XL
XXL
5. Additional Participants
*
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None
Adult Candidate
Junior Candidate (12-16 yo)
Child
5. Sub-Total Amount Due
6. Relationship
*
Please Select
Spouse
Child
Relative
Friend
Other
6. Name
*
First Name
Last Name
6. Date of Birth
*
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Month
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Day
Year
Date
6. Age
6. Gender
*
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Male
Female
6. T-Shirt Size
*
Please Select
S
M
L
XL
XXL
6. Additional Participants
*
Please Select
None
Adult Candidate
Junior Candidate (12-16 yo)
Child
6. Sub-Total Amount Due
7. Relationship
*
Please Select
Spouse
Child
Relative
Friend
Other
7. Name
*
First Name
Last Name
7. Date of Birth
*
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Month
-
Day
Year
Date
7. Age
7. Gender
*
Please Select
Male
Female
7. T-Shirt Size
*
Please Select
S
M
L
XL
XXL
7. Additional Participants
*
Please Select
None
Adult Candidate
Junior Candidate (12-16 yo)
Child
7. Sub-Total Amount Due
8. Relationship
*
Please Select
Spouse
Child
Relative
Friend
Other
8. Name
*
First Name
Last Name
8. Date of Birth
*
-
Month
-
Day
Year
Date
8. Age
8. Gender
*
Please Select
Male
Female
8. T-Shirt Size
*
Please Select
S
M
L
XL
XXL
8. Sub-Total Amount Due
Consent Form & Liability Waiver
Consent Form & Liability Waiver* DEFINITIONS: • The term “TEAM MEMBER” shall collectively be referred to the participants and/or the attendees referenced as Adult, Couple, Child. • The term “ACTIVITY” shall refer to the event and activity referenced above. • The term “CLAIMS” shall refer to any and all liability, claims, demands, debts, causes of action, suits, judgments, costs, losses, expenses, attorney’s fees, and any other obligations. • The term “HOST” shall refer to the sponsors of the program, Christian Unity Church, and its directors, officers, affiliates, successors, predecessors, parents, subsidiaries, pastors, principals, shareholders, interns, employees, volunteers, teachers, staff members, drivers, administrators, security guards, agents, members, and any other representatives. INFORMED CONSENT: I, the undersigned, am the participant, spouse and/or parent and/or legal guardian of a minor and hereby understand the various aspects of the ACTIVITY. I understand that I, my spouse, and/or a child could sustain serious personal injuries, illness, property damage, or even death as a consequence of not only the HOST’s actions, inaction, or negligence but also the action, inactions, or negligence of others, conditions of equipment used, and that there may be other risks not known or not reasonably foreseeable at this time. I further understand and agree that any injury, illness, property damage, disability, or death that I, my spouse, and/or a child may sustain by any means is my sole responsibility. I consent that I, my spouse, and/or a child are permitted to receive medical treatment which may be deemed advisable and reasonable in the event of injury, accident, and/or or illness during the ACTIVITY. ASSUMPTION OF RISK: I, the undersigned, am the participant, spouse and/or parent and/or legal guardian of a minor and hereby request that I, my spouse, and/or a child be permitted to participate in the ACTIVITY. I understand that participation in the ACTIVITY presents a certain inherent risk of injury to I, my spouse, and/or a child that cannot be eliminated regardless of care taken. The ACTIVITY may involve various activities such as lectures, physical exercise, sporting activities, travel, consumption of food, weather conditions, negligent or willful acts, supervision, and first aid treatment. I certify that I, my spouse, and/or a child are physically and mentally fit to participate in the ACTIVITY. In exchange for I, my spouse, and/or a child knowingly and voluntarily agree to fully assume any and all risks for injuries whatsoever whether known or unknown arising out of or related to the participation in the ACTIVITY. RELEASE AND WAIVER OF LIABILITY: As a condition of the participation in the ACTIVITY, I, on behalf of myself, my spouse, child, and my representatives, heirs, executors, trustees, administrators, agents and assigns hereby will and do release, waive, discharge, and covenant not to sue the HOST for any and all CLAIMS of any kind whatsoever whether known or unknown arising out of, or related to, any injuries, property damages, and death as a result of directly or indirectly participating in the ACTIVITY even if the CLAIMS are caused by the negligence of the HOST. I understand that I, my spouse, and/or a child may be photographed, videotaped, or otherwise recorded during the ACTIVITY. I fully authorize the use of these photos, images, videos, sound or other recordings, including likeness, in promotional materials by the HOST. I understand that neither myself, my spouse, child nor the undersigned parent/guardian will receive any royalties or compensation for the use of these materials. INDEMNITY: As a condition of the participation in the ACTIVITY, I, on behalf of myself, my spouse, child, and my representatives, heirs, executors, trustees, administrators, agents and assigns agree to hold harmless, defend and indemnify the HOST for any and all CLAIMS of any kind whatsoever whether known or unknown arising out of, or related to, any injuries, property damages, and death as a result of directly or indirectly participating in the ACTIVITY even if the CLAIMS are caused by the negligence of the HOST. CHOICE OF LAW & SEVERABILITY: I hereby agree that this waiver and release shall be construed in accordance with the laws of the State of Georgia and that this waiver and release is intended to be as broad and inclusive as permitted by such law. I further agree that if any portion herein is held invalid, the balance shall, notwithstanding, continue in full force and effect. I certify that I have read and fully understand the contents of this document. I am aware that this constitutes a release of liability and forms part of a contract. I agree to this willingly and sign it of my own free will.
Upon reading and agreeing to the Consent Form & Liability Waiver, please sign here:
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Donation payment method
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Zelle Amount Due
Zelle Payment Method
Please send Zelle payment to: 2024cuc@gmail.com and put "TRESDIAS1" in memo section.
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