Event Registration

Preferred Language English Spanish Parent or Guardian First Name: Parent or Guardian Last Name: Gender: Male Female Prefer not to say Birth Date: / / T-Shirt Size Adult XS Adult Small Adult Medium Adult Large Adult X-Large Adult 2XL Adult 3XL Youth Small Youth Medium Youth Large Adult 4XL Number of Attendees: Parent or Guardian Contact Phone: Parent or Guardian Contact Email: Would you like us to provide free transportation? Yes, please. No, thank you. Address for Pickup & Dropoff: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Emergency Contact Name Emergency Contact Phone Number RELEASE OF LIABILITY: By signing this Release of Liability, I expressly warrant that I am capable of withstanding both the physical and mental demands of For The Need programs and activities that are attended. Whether such risks are known to me at this time, I further release For The Need and its directors, staff, mentors, volunteers, and agents from any claim that I may have against them because of injury or illness incurred during the participation in the activities. This release of liability shall include, without limitation, any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims of that members of the child’s family or estate, heirs, representatives, or assigns may have against the For the Need Foundation or its directors, staff, mentors, volunteers, or agents. I, on behalf of myself, my heirs, assigns, and personal representatives, further agree to indemnify and hold harmless For The Need and its directors, staff, mentors, volunteers, or agents from any and all claims arising from the participation in the programs and activities, or as a result of injury or illness of my child during such activities. I acknowledge that participating in the programs and activities of For the Need Foundation incurs certain risks associated with these activities, including by way of example, physical injury, illness, or even death due to transportation and program/activity-related accidents. I acknowledge that there may also be other risks in these activities that I am not presently aware. Final Statement: I hereby agree to participation in the above stated programs and activities of For The Need, I hereby consent to the Release of Liability, and agree that this shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. This Agreement shall be valid for the entire length of time I participate in For The Need’s program. Yes, I agree for myself and for each child I register for For the Need events. Permission of Materials Agreement: For the Need Foundation (FTN) is a non-profit organization dedicated to changing the lives of youth experiencing homelessness, poverty, and chronic illness. We communicate with children, their support networks, with the public and with organizational supporters though a variety of media, including in person, print, and online.For the Need Foundation may record events at which you are present, the recording might be a photograph, an audio recording, a video, or the like, and may be in any medium (digital, print, and new media) ("Materials"). We use Materials solely in furtherance of our mission; for example, in a newsletter, on our website and other social media, and in materials we distribute describing and promoting For the Need Foundation and in fundraising efforts. We wish to confirm your permission of For the Need Foundation to useMaterials that contain your image or voice ("Likeness").By signing this Permission of Materials Agreement ("Agreement"), you confirm that For the Need Foundation may use Materials containing your Likeness. "Use" means copy, edit, combine with other content, publish, broadcast, exhibit, televise, portray, distribute, and otherwise exploit the Materials in any medium now known or later developed solely to support the mission of For the Need Foundation. This permission is for Materialscreated prior to and after the date you sign this Agreement. If you wish to change the terms of your permission, please write to For the Need Foundation at 2003 Royal Ave, Simi Valley, CA 93065 (Attention: Operations Manager) or by email info@fortheneed.org or by calling (805) 328-0970.You acknowledge that you sign this Agreement freely and with no promise of compensation from For the Need Foundation and that you are over the age of 18 (or that you are the parent or guardian of someone that is under the age of 18); that it is binding upon you and your personal representative/heirs; and that the Materials are the exclusive property of For the Need Foundation and the Bow & Arrow Mentorship Program. Yes, I agree for myself and for each child I register for For the Need events. No, I do not agree. I am not sure at this time, but you may ask me again later. PARENT / GUARDIAN CONSENT AND AGREEMENT FOR EMERGENCIES:As parent/guardian, I consent to have my child receive first aid by facility staff and, if necessary, be transported to receive emergency care. I will be responsible for all charges not covered by insurance. I consent for the emergency contact person listed to ACT ON MY BEHALF until I am available. Yes, I agree for myself and for each child I register for For the Need events. TECHNOLOGY AGREEMENT: For the Need Foundation is starting a program where children ages 11 and up may have the opportunity to be paired with a mentor to contact each other between events using our child safe app called MentorHub. MentorHub allows for staff to pair mentors and mentees with mentor, mentee, and guardian consent. Staff will oversee the connection and ensure both parties' remain comfortable and in compliance with our safety & security policies. Yes, I give my 11+ aged child(ren) permission to download our child-safe app and pair with a mentor if they so choose. No, I do not give permission to my 11+ aged child(ren) permission to download our app. I am not sure at this time, but you may ask me again later. If you want to change any of the information you have provided including addresses, names, permissions, and more, you can do so online at www.fortheneed.org/members or by emailing info@fortheneed.org with the subject line "INFORMATION CHANGE" I understand. Relation of Registrant to Attendees:   Same Household Same Company