Epworth UMC /EPWORTH FOUNDATION/Talent Camp Free Breakfast & Lunch Served 8 a.m. - 3:30 p.m. March 24-28, 2008 Music, Dancing, Crafts, and much more!   Registration Form Complete the form below, then print it and bring it to 3401 High Street.   STUDENT NAME:         Age:                                         Sex:  (m/f) choose 1 Male Female Address:                           City, State, Zip:                Parent / Guardian Name:  Emergency contact name:  Emergency contact number(s) Email address (if available):  Parent/Guardian Signature_______________________________________________________________   Student signature: _____________________________________________________________________ Print this form and then press 'SUBMIT'         In view of the fact that the sponsoring organization, Epworth United Methodist Church (EUMC, and Epworth Foundation are  charitable organizations, the following Waiver and Release and Photography Consent Release for Minor Child are required to be signed and returned to the Talent Camp coordinator, prior to the commencement of a youth’s participation in the camp. WAIVER AND RELEASE FOR MINOR For and in consideration of permitting the undersigned Youth Participate to enroll in and participate in the Talent Camp, the undersigned hereby freely and voluntarily releases, discharges, waives, and relinquishes any and all claims, demands, proceedings, actions, causes of action (at law, in equity, administrative or otherwise), civil actions, rights of action and remedies of every kind and nature whatsoever, whether known or unknown, asserted or unasserted, discovered or undiscovered, including without limitation any claims for design or construction defects or deficiencies whether latent, patent or otherwise (hereinafter collectively referred to as “Claims”), and from any and all obligations, duties, liabilities, damages, losses, fines, penalties, assessments, fees, costs and expenses (including without limitation, any claims for attorneys fees, costs and litigation expenses) of every kind and nature, known or unknown, discovered or undiscovered (hereinafter collectively referred to as “Damages”) which arose from the beginning of time up to the date of the execution of this Agreement for personal injury and/or economic injury occurring to himself/herself arising as a result of engaging in said activity or activities incidental hereto, wherever or however the same may occur and for whatever period said activities, and the undersigned does for him/herself, his/her heirs, executors, administrators, and assigns hereby release, waive, discharge, and relinquish any action or causes of action, aforesaid, which may hereafter arise for him/herself and his/her estate, and agrees that under no circumstances will he/she or his/her heirs, executors, administrators, and assigns prosecute or in any way whatsoever, present any claim for personal injury and/or economic injury against Epworth United Methodist Church or any of its officers, agents, servants, insurers, agents, attorneys, representatives or employees  IT IS THE INTENTION OF THE UNDERSIGNED BY THIS INSTRUMENT, TO EXEMPT AND RELIEVE EPWORTH UNITED METHODIST CHURCH, ANY VOLUNTEERS AND/OR AGENTS AND THE TALENT CAMP PROGRAM FROM LIABILITY FOR PERSONAL INJURY AND/OR ECONOMIC INJURY CAUSED BY NEGLIGENCE.   ______________________________                        _________________________________ Signature of Youth Participant                            Date   ______________________________                        _________________________________ Signature of Parent or Guardian                         Date   PHOTOGRAPHY CONSENT RELEASE FOR MINOR CHILD   I, ___________________________, parent or official guardian of ___________________________ hereby grant permission to Epworth United Methodist Church, and Epworth Foundation, its employees or representatives, to take and use photographs, videotape and digital images of my child for use in promotional or educational materials as follows:  printed publications or materials, electronic publications or presentations and websites.  I agree that my child’s name and identity may be revealed in descriptive text or commentary in connection with the image(s).  I authorize the use of these images indefinitely without compensation to me.  All negatives, prints, digital reproductions and videotape shall be the property of Epworth United Methodist Church. ______________________________                        _________________________________ Signature of Parent or Guardian                                     Date   ______________________________                        _________________________________ Address                                                                      City/State/ZipCode         ______________________________                        _________________________________ Signature of Witness for EUMC                                    Date
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