Event Registration

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AGIOS Challenge 2022 on Sunday, August 21, 2022 @ 4:00 PM

This form serves as a waiver/release and so it must be completed by an adult (either the parent/guardian of a student or an adult who is registering to participate themselves). Parents/guardians may only register their own children on this form.

*Participant Category
*Do you normally attend West Shore Free Church?
If not, who invited you?
 Must register by Aug 4 to be guaranteed a t-shirt. Additional shirts may be available for sale, first come-first serve. 
T-Shirt Size:
If participant has special needs, please provide any additional information that would be helpful:
*Parent's First Name:
*Parent's Last Name:
*Emergency Contact Number:
*Parent's Email Address:
*The undersigned does hereby give permission for the above-named child to attend and participate in all activities during the AGIOS Challenge, including, but not limited to the climbing wall, mud pit, water slide and other obstacles on Sunday, August 21, 2022 at West Shore Evangelical Free Church, Mechanicsburg, Pennsylvania. I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including but not limited to the following: sickness, exposure to infectious/ communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. I understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the staff or sponsor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child's well-being. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the 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 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 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 agreeable alternative dispute 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 in accordance with the  rules of the American Arbitration Association.

I also give permission to WSEFC to use photographs and/or video taken during the event for promotional purposes such as the web site, brochures, etc.

I, the undersigned parent/guardian, agree to all of the above statements and my full printed name below represents my electronic signature.
You can register another participant by clicking "Next" and then "Register Another Person"