Welcome

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Member Name* This field is required.
First Name
Last Name
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Member Age* This field is required.
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Member Grade* This field is required.We are only accepting middle school and high school age members at this time.
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Member School* This field is required.
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Parent/Guardian Name* This field is required.
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Parent/Guardian Email* This field is required.
example@example.com
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Parent/Guardian Phone Number* This field is required.
Area Code
Phone Number
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Are you willing to download an app to your phone for communication purposes?* This field is required.
YESNO
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Do you understand that is it the Parent/Guardian's responsibility to provide transportation to and from bi-weekly meetings and that meeting may take place in diverse locations across Northwest Indiana?* This field is required.
YESNO
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Do you commit to being a "highly engaged" parent/guardian? This includes helping with two annual fundraising events, chaperoning field trips, occasionally donating snacks and drinks, participating in parent advisory committee meeting 4 times per year, and offering any expertise or talents you may have to help Move achieve it's mission?* This field is required.
YESNO
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Do you understand that if you choose for your child to participate in the Move 6 Week Summer Session, there may be an additional cost (depending on the success of of our fundraising efforts)?* This field is required.
YESNO
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HOLD HARMLESS AGREEMENT

This Hold Harmless Agreement ("Agreement") is entered into on the date of this registration, by and between Uthiverse Move Male Mentoring Program ("Program") and Parent ("Participant").

1. Purpose: The purpose of this Agreement is to outline and acknowledge the terms and conditions under which the Participant agrees to release and hold harmless the Program from any and all liabilities, claims, demands, and causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Participant or to any property belonging to the Participant while participating in the Program.

2. Assumption of Risk: The Participant understands that participation in the Program involves certain inherent risks, including but not limited to physical activities, transportation, and interactions with other participants. The Participant voluntarily assumes all risks associated with participation in the Program.

3. Release and Waiver: In consideration for being permitted to participate in the Program, the Participant agrees to release, waive, discharge, and hold harmless Uthiverse, its officers, directors, employees, agents, and volunteers from any and all claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Participant or to any property belonging to the Participant while participating in the Program.

4. Indemnification: The Participant agrees to indemnify and hold harmless Uthiverse, its officers, directors, employees, agents, and volunteers from any and all claims, demands, actions, or causes of action, including attorney’s fees and costs, arising out of or related to the Participant’s involvement in the Program.

5. Medical Treatment: The Participant consents to receive medical treatment deemed necessary if the Participant is injured or requires medical attention during participation in the Program. The Participant agrees to be responsible for all costs associated with such medical treatment.

6. Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state of Indiana.

7. Entire Agreement: This Agreement constitutes the entire agreement between the parties and supersedes all prior agreements or understandings, whether written or oral, relating to the subject matter hereof.

8. Severability: If any provision of this Agreement is found to be invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect.
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I understand and agree to the Hold Harmless Agreement* This field is required.
Yes
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Please verify that you are human* This field is required.
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