Youth Event Registration and Release - Rumpus Registration, photo/video & liability release 2024 Youth Name(Required) First Last PronounsCurrent Grade (or Home School Equivalent)PhoneHome Congregation(Required)Responsible Adult (#1) Name(Required) First Last Responsible Adult (#1) Email Responsible Adult (#1) Cell(Required)Responsible Adult (#2) Name First Last Responsible Adult (#2) CellResponsible Adult (#2) Email Emergency Contact(Required) First Last Emergency Contact Phone Number(Required)Any Dietary Needs/Restrictions?Please specify t-shirt size:Children's SmallChildren's MediumChildren's LargeAdult SmallAdult MediumAdult LargeAdult XLWould you be interested in volunteering for a 2-hour shift? 10am - noon Noon - 2pm 2pm - 4pm 4pm - 6pm (For those on the 4-6 shift, it will be ok if they want/need to leave when their kid is ready.) Would you be interested in volunteering for 1-hour as kids are arriving? 9am - 10am Can images or likenesses of my child be shared in regional or NTUUC publications including the website? Unless you indicate so below, your youth's likeness may appear in regional publications including the website and Facebook. Your youth will not be identified by name.(Required) Yes No Sharing Contact Information: Please check the box to give consent to share your contact info.(Required) Please check here if your family's contact information can be shared with other attendees. Often our youth make friends at this event and we would like to facilitate friendships with UU youth in other congregations. Your "check" confirms your consent.Liability Release: Please check the box to give consent for youth to participate in the event’s activities.(Required) I hereby voluntarily release, discharge, and agree to indemnify and hold harmless the NTUUC and Horizon UU Church from any and all claims, demands, or causes of action that are in any way connected with my youth’s participation in rUmpUs events. Your "check" confirms your consent.Liability Release: Please check the box to assume liability for your youth to participate in the event’s activities.(Required) I certify that I have adequate insurance or am otherwise able to cover any injury or damages that my child may cause or suffer while participating in rUmpUs events. I further certify that I am willing to assume the risk of any medical or physical condition my child may have. Your "check" confirms your consent.Registration(Required) Price: Payment MethodCredit CardPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Paying with a PayPal account or looking for other options including Venmo* and iDeal? Please click on the gray "Credit Card" button above and select "PayPal Checkout." (* Note: Venmo will only shown on mobile devices if you have their App installed.)
