Cadet Signup - Westend Church

Cadet Signup below!

Cadet Registration

May 15 deadline
Cadet Information

*If you are signing up more than one cadet please fill out seperate entries forms for each
Cadet Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Church/Club *
Club Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Parent/ Guardian 1 *

First Name Last Name
Home Number
Cell Number Parent/ Guardian 1 *
Email
example@example.com
Parent/ Guardian 2

First Name Last Name
Home Number
Cell Number Parent/ Guardian 2
E-mail
example@example.com
Emergency Information
Emergency Contact’s Name *

First Name Last Name
Backup Emergency Contact’s Name *

First Name Last Name
Relationship *
Relationship *
Phone Number *
Phone Number *
Alt. Phone Number
Alt. Phone Number
Does the Cadet have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the Cadet prescribed any Medication or Inhaler? If yes, please explain any instructions. *
Please list any special needs, limitations, and adaptions for the Cadet. *
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Grand Rapids North Council during the selected camp. In exchange for the acceptance of said child’s candidacy by Grand Rapids North Council. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Grand Rapids North Council and all its respective officers, agents, and representatives and the Cadets home church and its cadet councilors/club from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Grand Rapids North Council including all its respective officers, agents, representatives, coaches and affiliates, all participants, sponsoring agencies, advertisers, Cadets home church and its cadet councilors/club and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, swimming, outdoor activity, and camping. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Parent/ Guardian Signature *

Clear
Medical Release and Authorization

As Parent and/or Guardian of the named Cadet, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named Cadet. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact Parent/ Guardian in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach Parent/ Guardian.

Permission is also granted to the Grand Rapids North and its affiliates including Directors, Coaches, and and Cadet Councilors to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Parent/ Guardian Signature *

Clear
Confirmation

BY ACKNOWLEDGING AND SIGNING, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Attn:

Cadets are required to bring a life jacket to the Grand Rapids North Camporee
Please verify that you are human *
Should be Empty:

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