Convention - Youth Form | Colorado DeMolay

Youth Registration - Colorado Convention 2024

Registration Deadline - May 19, 2024

ISLAND WAIVER MAY BE FOUND HERE - Island Waiver

ISLAND RULES AND MAP MAY BE FOUND HERE - Island Rules and Map

Full Name of Registrant

Parent/Guardian's Name

Address

Email Address

Age at Date of Convention

Chapter/Jurisdiction/Position/Title

Dietary Requirements, ie.: kosher, vegetarian, gluten free, etc.

Shirt Size

Meal Choice Options

Amount Per Room

Awards and Honors received

Release

Release statement 1

I give permission for my child to join the DeMolay of Colorado, in the activities sponsored by the State Organization, its staff, and sponsors. I hereby release them from responsibility and liability from any illness or injury that my child may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity as agent for me, to consent to an x-ray examination, medical, dental or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in any hospital. I will expect to be contacted as soon as possible.

Release statement required for all DeMolay participating in Colorado Convention 2024. This form must be signed by a parent.

Release Electronic signature - Type full name if under 18. Parent's full signature is required

By simply registering online for Colorado Convention 2024, you hereby agree on your own behalf and/or the parent or legal guardian of the participant at Colorado Convention, the participant will conform to and abide by statutes, rules, regulations, and edicts of DeMolay International, Jurisdiction of Colorado, the staff, DeMolay representatives, our sponsors, and all rules and regulations applying to the Colorado Convention event. By your acceptance of this online registration, you hereby agree that if in the event, that an advisor, the Colorado Event/Convention director, state staff, or the Executive Officer have determined you need to be removed or asked to leave any activity for violation of the rules, the participant and/or the parents will immediately take all necessary action to cause the transportation of the violator from the site at the sole expense of the member and/or parents. By registering online for Colorado Convention 2024, you agree and acknowledge that participation in DeMolay activities involves a certain degree of risk. You have decided to register and have given your consent for yourself and/or your child to participate in these activities. Your acceptance of online registration and this online registration form gives your approval and understanding that participation in these activities is entirely voluntary and requires participants to abide by the applicable rules and such acceptance of this online registration, you further release the Chapter, the Jurisdiction of Colorado, DeMolay International, active members, employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this event.

Consent-Release Electronic signature - Type full name if under 18. Parent's full signature is required

I grant permission to the jurisdiction of Colorado and it's subordinates, including all Chapter(s) and related organizations to use my photo for use in DeMolay publications such as recruiting brochures, newsletters, and magazines, and to use my name and/or photographs on display boards, any photographs in electronic versions of the same publications or on the Colorado DeMolay website or other forms of social media.

Media-Release Electronic signature - Type full name if under 18. Parent's full signature is required

Allergies

Physical Handicaps

Medications Currently Being Taken

Medical Insurance Provider

Name of Policy Holder

Policy Number

In the event of an emergency involving the participant listed under the Colorado DeMolay State Convention registration, I understand every effort will be made to contact the emergency contact listed. In the event that he/she cannot be reached, the participant and/or the parent/legal guardian hereby give permission to the medical provider selected by the adult leader in charge for treatment, including hospitalization, anesthesia, surgery, or injections of medication for the participant. Medical providers are authorized to disclose their examination findings, test results, and treatment provided for the purposes of medical evaluation of the participant, follow-up and communication with the parent or guardian, and/or determination of the participant's ability to continue in the programmed activities.

Emergency Information

Emergency Contact #1

Emergency Phone #2

Youth will not be allowed to participate without a permission slip signed by your Parent/Guardian on file. I give permission for my child to join the DeMolay of Colorado, in the activities sponsored by the State Organization, its staff, and sponsors. I hereby release them from responsibility from any/all illness or injury that my child may sustain during this activity/event. In the event of an emergency, I hereby authorize an adult leaderof this activity as agent for me, to consent to an x-ray examination, medical, dental or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where the services are rendered, either at a doctor's office, urgent care facility, or in any hospital. I will expect to be contacted as soon as possible.

Permission Signature - Type full name, if under 18 parent's full signature is required.

I have read, with my parents, and I fully understand and agree to all of the Guidelines for this event.

I have read, understand, and agree to all required release waivers.

I have read, with my parents, and have their permission to participate in all activities at Colorado's Convention 2024. They have signed all waivers and permissions.

My parents and I have provided current and accurate information.

Agreement to Guidelines and Waivers

Youth will not be allowed to participate without a permission slip signed by your Parent/Guardian on file.

By selecting "I accept" you consent to be bound by all conditions and terms. You also agree that your electronic signature throughout this form will serve as the legal equivalent of your handwritten signature.

I accept

Parent signature - I give permission for my child to participate in the Colorado Convention, have signed all waivers and permissions, and understand the rules and guidelines of this event