Student Attendee Registration

STUDENT ATTENDEE REGISTRATION

Purpose: This form registers the student for participation in the listed program or event and records emergency, medical, and authorization information. Completion of this document constitutes binding consent for emergency care, transport (if checked), and administrative rules identified below. Please print clearly.

Student Information

Student Name:

Parent / Guardian Information (If Student is a Minor)

Program / Event Details

Emergency & Medical Information

Accommodations & Special Instructions

Authorizations, Acknowledgments, and Releases

Participation Authorization: I authorize the above-named student to participate in the program or event described on this form. I understand that participation may include supervised activities and group instruction.

Emergency Medical Treatment: In the event of illness or injury, I authorize program staff to obtain emergency medical treatment for the student if I cannot be reached. I understand that reasonable attempts will be made to contact the parent/guardian prior to non-emergency treatment when feasible.

Transportation: I authorize the student to be transported by program-designated vehicles or drivers for scheduled activities, field trips, or emergency transport.

Photo / Media Release: I grant permission for photographs, audio, or video recordings of the student taken during program activities to be used by the program for educational, promotional, or documentation purposes. I understand no personal contact information will be published without separate consent.

Financial Agreement: I agree to pay the fees identified above according to the payment arrangement. I acknowledge the program's refund and cancellation policies as stated in the program materials and accept responsibility for charges incurred.

Code of Conduct Acknowledgment: I have read and will ensure the student complies with the program's code of conduct, safety rules, and disciplinary policies. I understand that failure to comply may result in dismissal without refund.

Release and Liability: By signing below, I release and hold harmless the program, its employees, volunteers, and agents from liability for injury, loss, or damage that is not the result of gross negligence or willful misconduct. I authorize the program to take reasonable actions necessary to protect the student's health and safety.

Optional Authorizations and Notices

Medication Administration: I authorize program staff to assist with or administer prescribed medications as directed in writing and consistent with program policies. I will provide labeled medications and written instructions as required.

Special Medical Instructions Provided:

Certification

I certify that the information on this form is true and correct to the best of my knowledge. I understand that falsification or omission of material information may result in denial of participation or immediate dismissal. I agree to notify program administrators promptly of any changes to the information provided.

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