Waivers & Minor Sponsorship Forms – Colorado East Bahai School

Waivers & Sponsorship Agreement

Waiver of Liabilty – Summer School

We look forward to seeing you at Summer School! All adults must sign a waiver of liabilty and Parents/Guardians of minors must sign a medical release. You must be 18 years old or older to sign.

**Minors under age 18 who are attending without a parent or legal Guardian, must have a parent or Guardian fill out this form on their behalf. Parents sending a minor with a sponsor – please fill in your name & contact information under “Adult 1”, choose how many minors are attending, enter the child’s information and sign all fields.

Completing this form in advance will speed up registration on arrival. If you have questions please contact the Registrar (Lynn) at 303-489-9844 or coloradoeast-reg@nbs.usbnc.org.

Family/Group member information

How many adults are you signing for today?

Adult 1

Or Parent/Guardian name for a child attending with a sponsor)

Adult 1

First

Last

Phone

Adult 1 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Adult 1 Medical Insurance Company, Policy/Member ID/Group # & Phone #

Adult 2

First

Last

Phone

Adult 2 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Adult 2 Medical Insurance Company, Policy/Member ID/Group # & Phone #

Adult 3

First

Last

Adult 3 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Adult 3 Medical Insurance Company, Policy/Member ID/Group # & Phone #

Minors Information (under age 18)

Minors Sponsorship – Attending without a Parent/Guardian

Will any children be attending without their legal Parent or Guardian?

Yes

Please list the adult Sponsor’s name.

A sponsor must be 21 years or older and willing to be resonsible for the welfare, well-being and conduct of the minor.

Signature acknowledging Sponsorship (read statements below signature box)

Clear

I am the Parent or Guardian of the below named child(ren) and hereby indicate my understanding and approval of the sponsorship and give the above-named sponsor aurhority to execute the School’s Waiver of liability on my behalf.

I understand and agree that my child(ren)’s personal information, including name, address, phone number, date of birth, grade level, special needs (medical and learning-related), may be entered into a registration form, which may be maintained in an electronic version, and the National Spiritual Assembly of the Baha’is of the United States and its Baha’i School Committees will not sell this information to anyone or share it with anyone except when required by law.

Child 1

First

Last

Your relationship to Child 1

Child 1 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Child 1 Emergency contact (name, phone & relationship)

Child 1 – Family Physician name & phone

Child 1 – Medical Insurance (or note if same as listed under adults). Please include Insurance Company, Policy/Member ID/Group # & Phone #

Child 2

First

Last

Your relationship to Child 2 (parent, relative, sponsor, etc.)

Child 2 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Child 2 Emergency contact (name, phone & relationship)

Child 2 – Family Physician name & phone

Child 2 – Medical insurance (or note if same as listed under adults). Please include Insurance Company, Policy/Member ID/Group # & Phone #

Child 3

First

Last

Your relationship to Child 3 (parent, relative, sponsor, etc.)

Child 3 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Child 3 Emergency contact (name, phone & relationship)

Child 3 – Family Physician name & phone

Child 3 – Medical insurance (or note if same as listed under adults). Please include Insurance Company, Policy/Member ID/Group # & Phone #

Child 4

First

Last

Your relationship to Child 4 (parent, relative, sponsor, etc.)

Child 4 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Child 4 Emergency contact (name, phone & relationship)

Child 4 – Family Physician name & phone

Child 4 – Medical Insurance (or note if same as listed under adults). Please include Insurance Company, Policy/Member ID/Group # & Phone #

Child 5

First

Last

Your relationship to Child 5 (parent, relative, sponsor, etc.)

Child 5 Allergies/Medical Needs

Please list any allergies and/or medical needs or concerns for the person above.

Child 5 Emergency contact (name, phone & relationship)

Child 5 – Family Physician name & phone

Child 5 – Medical Insurance (or note if same as listed under adults). Please include Insurance Company, Policy/Member ID/Group # & Phone #

Waiver of Liability

By signing below I accept on behalf of those named above the acceptance of terms and waiver of liability as listed below.

Location: La Foret Conference & Retreat Center, 6145 Shoup Rd, Black Forest, CO 80908
Dates: September 1-4, 2023
Sponsored by: Colorado East Baha’i School, an agency of the National Spiritual Assembly of the Baha’is of the United States

Waiver: I understand that during participation in this event one may be exposed to physically and psychologically stressful and challenging situations, including but not limited to, risks and dangers inherent in the activity itself, exposure to forces of nature, motor vehicle travel and possible accident or illness.

If a minor is attending with a sponsor instead of a parent/guardian, the parent/guardian has advised the sponsor of any special needs of the participant or activities from which the participant should be restricted.

I understand that, although precautions have been taken to provide proper organization, supervision, instruction and equipment for each activity, it is impossible to guarantee absolute safety. I understand that I share responsibility for the safety of the participant and assume that responsibility.

I hereby assume all risks and dangers and will hold harmless the National Spiritual Assembly of the Bahá’í’s of the United States, the Bahá’í School Committee, all local Spiritual Assemblies, their officers, agents, and employees and all groups and persons connected herewith, from all actions, causes of actions, suits and any claims, demands, and liabilities whatsoever, both in law and equity, and or any of their respective officers, agents, and employees, in connection with participating activities, except in cases of gross negligence.

The terms hereof shall be binding on my executors, heirs, administrators, and assignees, and shall serve as an assumption of risk and general release for the participant while participating in this event.

Signature of Family Leader or Parent of Minor being sponsored

Clear

Minor Medical Release

I, the undersigned parent or guardian of the minors listed above, do hereby authorize Colorado East Bahá’í School, or its designated representative, agent(s) for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

As the parent/guardian of the above-listed minor(s) under the age of 18, I understand that this authorization enables Colorado East Bahá’í School to arrange medical care for my dependant minor(s) in the event I am unavailable. I understand that I am responsible for payment of any and all medical expenses incurred on behalf of my dependent minor(s).

This authorization shall remain effective from 9/1/2023 – 9/4/2023 only while my child(ren) is (are) attending the Colorado East Bahá’í School.

Signature for Minor’s Medical Release

Clear

Photo & Audiovisual Release

By signing below I accept on behalf of those named above the acceptance of the policy listed below.

This Colorado East Bahá’í School event is a public space. Photos may be taken during your visit and shared in publications (websites, e-newsletters, and other promotional materials). If this is not acceptable for you or anyone in your party, please let us know by requesting a Photo Decline Form from the Registrar (Lynn) at 303-489-9844 or coloradoeast-reg@nbs.usbnc.org.

Please Note this does not cover photos taken and used by other guests (including those posted on social media).

I have read and understand this information regarding the use of photos.

Signature for Photo Release

Clear

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