Signature of Participant definition

Signature of Participant. Date: Name of Participant: Name & Date of Trip: To file digitally please fill out the signature field LAST, save, and e-mail the form to us at xxxx@xxxx.xxx

Signature of Participant. Print Name: Address: Phone: Date: PARENTS OR GUARDIAN’S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18) In consideration of (print minor’s name) being permitted by the Board to participate in its activities and to use its equipment and facilities, I agree to the assumption of risk, indemnification and waivers as described above on behalf of myself and on behalf of Minor, and which are in any way connected with such use or participation by Minor.

Signature of Participant. Date: Name of Participant: Name & Date of Trip:

Examples of Signature of Participant in a sentence

• Signature of Parent/Guardian of Minor Date Signature of Participant Date Assumption of Risks: Participation in The Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries.

• Signature of Participant: Date:Spousal Consent (only required if your spouse is not the primary beneficiary - see note below).The consent of spouse must be signed only if all of the following conditions are present:a.

• Name of Participant (printed) Signature of Participant (if over 18) Name of Parent or Legal Guardian (printed) Signature of Parent or Legal Guardian If participant is younger than 18 years If participant is younger than 18 years Phone number where parent/legal guardian Date can be reached in case of emergency.

• Printed Name of Participant Signature of Participant Date Date of Birth Emergency Contact Name Emergency Contact Number PARENTAL / LEGAL GUARDIAN CONSENT I attest that I am the parent or legal guardian of the minor participant named above.

• Name of parent/guardian: Signature of parent/guardian: Signature of Participant: Date: Video and Photographs Elevation Outdoors has permission to use my or my child’s photograph/video/audio recordings to promote the organization.

More Definitions of Signature of Participant

Signature of Participant. Date: 2nd Signature of Participant: Date: Signature of Parent or Guardian: Date: (Parent’s or guardian must sign for participants under the age of 18) EMERGENCY CONTACT INFORMATION Emergency Contact Name: Emergency Contact Number

Signature of Participant. Age: Date: [By signing this, I agree to follow the Guidelines and dress code and will be respectful and cooperative, obeying authority with a proper attitude at all times.] SIGNATURE OF PARENT/LEGAL GUARDIAN 1: Date: SIGNATURE OF PARENT/LEGAL GUARDIAN 2: Date: For GDSS Use Only:  Participant Verbally Certified that Signature(s) above is/are his/hers and Xxxxxx’s/Legal Guardian’s

Signature of Participant. Date: Print Name: Xxx XX: Acknowledged by: Date: Dr. Xxxxxxxx Xxxx, Xxxx, Xxxxxxx X. Xxxxxx Honors College I plan to reside in an Honors residence hall Yes No For more information on Honors housing, visit xxxxx://xxx.xxxx.xxx/academics/honors/ prospective/housing.html

Signature of Participant. Date: (Parent’s or guardian must sign for participants under the age of 18) Signature of Parent or Guardian: EMERGENCY CONTACT INFORMATION Date: Emergency Contact Name: Emergency Contact Phone: Canoe Club/Team Name:

Signature of Participant. ________________________________________________________Date:_________ For Participants Under 18 ___ I am signing this Agreement on behalf of a minor Participant. I acknowledge that I am the Guardian/Parent of the Participant and that I understand the terms of this Agreement. I also acknowledge that these terms shall bind my heirs and personal representatives and the heirs and personal representatives of Participant. ___ I grant permission for the University of Utah to take photos and videos of the participant during their stay at the Xxxx-Xxxxxxxxx Center for social media and promotional purposes. ___ I grant permission for the University of Utah to use any words or images produced by the participant during their stay at the Xxxx-Xxxxxxxxx Center for promotional purposes. Signature of Custodial Parent or Legal Guardian____________________________________________ Date: _____________ MEDICAL INFORMATION List any allergies and other pertinent medical conditions (i.e. asthma, diabetes, heart conditions, etc.): ___________________________________________________________________________________________ ___________________________________________________________________________________________ List any prescribed medications taken for the above mentioned medical conditions: ___________________________________________________________________________________________ Health Insurance Provider/ Policy Number: ___________________________________________________________________________________________ CONTACT INFORMATION Participant Name: ___________________________________________________________________ Driver’s License Number: ___________________________ State: ____ Home Phone: _____________________________________________________________ Address: __________________________________________________________________ Email: ____________________________________________________ Emergency Contact: ___________________________________________________ Relationship: ______________________________________________________________ Phone Number: ___________________________________________________________

Signature of Participant. Age: Date: SIGNATURE OF PARENT/LEGAL GUARDIAN 1: Date: SIGNATURE OF PARENT/LEGAL GUARDIAN 2: Date: For GDYM Use Only: 🞏 Participant Verbally Certified that Signature(s) above is/are his/hers and Xxxxxx’s/Legal Guardian’s SIGNATURE OF GDYM STAFF: Date: GDYM Event Registration Form, Request to Participate, Hold Harmless and Release Agreement Page 2 of 2 General Guidelines EVENT GUIDELINES

Signature of Participant. Date: If participant is under age 18: