SuperStart 2020 Registration

February 28-29 | Please complete the form below to register each child for this event.

Location: BLOOMINGTON, IL
Date: February 28-29
Ages: Grades 4-6
Cost: $60

Register by February 10
Please complete the form below to register each child for this event at Eastview Christian Church. This event will fill up. +++Deadline to sign up is February 10, 2020. 

SuperStart is February 28-29. 

Grades 4-6 

Bloomington, IL (transportation provided) 

$60 (includes gas & lunch on Saturday) 

SuperStart Website

http://www.ciy.com/superstart/ 


Parent Guide

http://ciy.com/media/ss/downloads/SS_Parent_Guide.pdf 


Additional forms may be necessary. If so, you will be contacted with a request for this information.
Child's Information

 
Please select one option.
 
 
Please select all that apply.
Parent/Guardian Information

 
 
 
Emergency Contact Information

 
 
 
Medical Information

 
 
Participation Agreement

I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.

In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Description

February 28-29
Please complete the form below to register each child for this event.

Location: BLOOMINGTON, IL
Date: February 28-29
Ages: Grades 4-6
Cost: $60

Register by February 10