Celebrating Wellness 2026 Registration Form 🎉

Celebrating Wellness 2026 Registration ENGAGE.EMPOWER.ELEVATE

Complete the participant details, select your activities, share health information, and sign the consent and waiver.
Participant Information
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender
School / Organization
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2
State / ProvinceCityPostal / Zip Code
Parent / Guardian Information
Parent / Guardian Name

First NameMiddle NameLast Name
Relationship
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact if Different
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Activities
Select Activities
Activity Risk Acknowledgment
Health Information
Do you have any medical conditions, allergies, injuries, medications, or support needs to report?
Please provide details
Photo & Video Consent
Photos and videos may be taken during this event for documentation and promotion, including social media, reports, and websites.
Consent choice
Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent / Guardian Consent (Under 18)
I confirm I am the parent/guardian of the participant and give permission for participation in Celebrating Wellness 2026. I understand and accept the risks involved and agree to the waiver terms above.
Parent / Guardian Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Relationship to Participant
Participant Declaration (18+ Only)
I confirm I understand and accept all terms of this form and voluntarily participate.
Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Organizer Use Only
Age Group
Consent Received
Waiver Completed
Staff Initials
Should be Empty:

Celebrating Wellness 2026 Registration ENGAGE.EMPOWER.ELEVATE

Participant Information

Parent / Guardian Information

Activities

Health Information

Photo & Video Consent

Parent / Guardian Consent (Under 18)

Participant Declaration (18+ Only)

Organizer Use Only