Adult Registration Form

First name

Last name

Phone Number

Home Address

Birthday

Home language(s)

Gender/Pronouns (optional)

Emergency Contact Information

Emergency Contact Full Name

Phone Number

Relationship

Health and Medical Information

Do you have any known allergies? (Food, insect stings, environmental, medication, etc.)

Do you have any medical conditions? (Asthma, diabetes, epilepsy, etc.)

Do you have any dietary restrictions? (Vegetarian, gluten-free, etc.)

Medical Insurance Provider & Policy Number (if known)

By signing below, I authorize Spring Forest to secure emergency medical care for me as needed in the event of an accident or illness

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Is there anything else you would like us to know about you?

By signing below, I give permission for photos/videos to be taken of me and used for promotional purposes by Spring Forest (grants, presentations, newsletters and social media). This is optional.

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Liability Waiver

SPRING FOREST ACTIVITIES

STATEMENT OF AUTHORIZATION AND CONSENT

I understand that participation in the Spring Forest program(s) (“activity” or “activities”) is voluntary and that any program of activity involves some element of risk. I agree that in partial consideration of Spring Forest (“organization”) sponsoring this activity and permitting individuals to participate, we will not attempt to hold Spring Forest, its officers, agents, and employees liable in damages for any injury or loss to person or property I might sustain while so participating; and I hereby release Spring Forest, its officers, agents, and employees from any liability whatsoever for any personal injury arising from participation in the program/activity.

RELEASE, ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND HOLD HARMLESS AGREEMENT

PARTICIPATION AGREEMENT

In return for Spring Forest allowing me to participate in Spring Forest activities and having read and understood this Participation Agreement, I hereby state that I agree to the following:

A. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Spring Forest, its officers, employees, or agents (hereinafter referred to as RELEASEES) for any liability, claim and/or cause of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by me that occurs as a result of participation in this activity.
B. I agree to INDEMNIFY AND HOLD HARMLESS the RELEASEES whether injury or damage is caused by my negligence, the negligence of RELEASEES, or the negligence of any third party from any loss, liability, damage or costs, including court costs and attorneys’ fees, that RELEASEES may incur due to participation in this activity.
C. It is my express intent that this RELEASE and HOLD HARMLESS AGREEMENT shall bind the members of my family, if I am or my child is alive, and my heirs, assigns and personal representatives, if I am deceased.
D. I understand that by participating in this activity I will ASSUME THE RISK of injury from risks and damages that are inherent in any activity.

I have read and understood the risks and agree to the terms above (Signature of Volunteer/Intern)

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Print full name as signed above

Date

Month

Day

Year

SOUL REVIVAL

Adult Registration Form

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