​Canoe Trip REGISTRATION FORM 

     (Date: July 14th 5pm-July 15th 6pm
    Location: Leaving Church at 5pm Canoeing in New York will be back around 6pm
    Cost: $25

    Permission and Release

    ​I give permission for my child to participate in this activity. In the
    event he/she is injured, I waive and release all rights to any claim for
    damages against the sponsor or its representatives. I further agree
    that any claim or dispute arising from or related to this
    agreement shall be settled by mediation and, if necessary, legally
    binding arbitration, in accordance with the Rules of the Institute for
    Christian Conciliation; judgment upon an arbitration award may be
    entered in any court otherwise having jurisdiction. In the event
    disciplinary action need to be taken against my child due to
    inappropriate behavior or misconduct, I understand that any
    expenses incurred will be the responsibility of the parent or guardian
    of the child.
     

    Medical Release

    ​In the event my child suffers sudden illness, accident, or injury and
    neither parents nor guardians can be contacted, I give permission for
    any emergency treatment that is deemed necessary by a licensed
    physician.  I assume responsibility for costs connected to accident/treatment of the child.
     

    Medical and Insurance Information

    Media Release

    ​I grant permission to North Rome Wesleyan Church to take images/videos of my child during this activity for the sole purpose of training, promotions and publications including Facebook postings, and waive any rights of compensation.  I understand that my child/children’s names will not be published with the image.