PADRE Foundation - Special-Event-Registration

2013 Snowy Nights-Teen Dinner and Dance
Dinner and Dance for Teens. 5:30 p.m. to 11:30 p.m.
Age must be at least 13 as of 12/14/2013.

Join the PADRE Foundation and Camp Conrad-Chinnock/Diabetes Camping and Educational Services for an evening of dinner, dancing, and socializing at Disneyland Paradise Pier Hotel. This event is for teens 13-18 years of age with diabetes AND their friends. The evening begins at 5:30 p.m. with dinner at 6:00 p.m. The evening will conclude at 11:30 p.m. Participants may leave earlier, but may not re-enter the event. The address of Disney's Paradise Pier is 1717 Disneyland Dr, Anaheim, CA 92802 Parents can drop-off in front of the hotel. As this is a semi-formal event, there is a minimum dress code.
Fees
$42

Please read any waivers carefully. They include releases of liability and waiver of legal rights and deprive you of the ability to sue certain parties. Do not agree to these documents unless you have read and understood it in its entirety. By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process. You also understand and agree that events carry certain inherent dangers and risks which may or may not be readily foreseeable, including without limitation personal injury, property damage or death. Your ability to participate in the event(s) is/are subject to your agreement to the waivers and by agreeing herein, you accept and agree to the terms of the waiver and release agreements.

By indicating your acceptance, you understand, agree, warrant and covenant as follows:
 
As a participant, whether a minor or adult, I will follow the following rules:
As a parent/guardian, I have reviewed the following rules with the participant:
 
PROXIMITY RULE: If the participant, whether a minor or adult, is with someone who is breaking any of the rules, that participant may lose the privilege of  participation in programs offered by the PADRE Foundation and/or Diabetes Camping and Educational Services, Inc./Camp Conrad-Chinnock as a participant, counselor-in-training, volunteer, and/or staff.
 
A participant will not:
1. Use or possess alcohol, tobacco, drugs, weapons, inhalants, and objects capable of defacing property (e.g., spray paint, permanent marker, etching tool, etc.).
2. Engage in any type of sexual contact.
3. Disregard the direct supervision of staff and/or volunteers.
4. Intentionally injure a person physically or emotionally or them self.
5. Destroy or deface property.
7. Intimidate or assault another person.
 
THERE ARE NO EXCEPTIONS TO THE RULES.
Any participant who does not follow these rules may:
1. Be promptly picked-up by their parent/guardian or, if an adult, depart the premises immediately,
2. Not be refunded program fees,
3. Be reported to law enforcement, and/or
4. Lose the privilege of participation in programs offered by the PADRE Foundation and/or Diabetes Camping and Educational Services, Inc./Camp Conrad-Chinnock as a participant, counselor-in-training, volunteer, and/or staff.
 
1. You represent and warrant that you have full legal authority to complete this event registration on behalf of yourself and/or any party you are registering (the "Registered Parties"), including full authority to make use of the credit or debit card to which registration fees will be charged. 
If you are registering a child under the age of 18 or an incapacitated adult you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you agree and consent to the collection of that child's information which you provide for the purposes of registration.
 
2.  Waiver.
YOU UNDERSTAND THAT PARTICIPATION IN THE EVENT IS POTENTIALLY HAZARDOUS, AND THAT A REGISTERED PARTY SHOULD NOT PARTICIPATE UNLESS THEY ARE MEDICALLY ABLE AND PROPERLY TRAINED.  YOU UNDERSTAND THAT EVENTS MAY BE HELD OVER PUBLIC ROADS AND FACILITES OPEN TO THE PUBLIC DURING THE EVENT AND UPON WHICH HAZARDS ARE TO BE EXPECTED.  PARTICIPATION CARRIES WITH IT CERTAIN INHERENT RISKS THAT CANNOT BE ELIMINATED COMPLETELY RANGING FROM MINOR INJURIES TO CATASTROPHIC INJURIES INCLUDING DEATH.   YOU UNDERSTAND AND AGREE THAT IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN THE EVENT, YOU AND ANY REGISTERED PARTY, THE HEIRS, PERSONAL REPRESENTATIVES OR ASSIGNS OF YOU OR THE REGISTERED PARTY DO HEREBY RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE ACTIVE FOR ANY AND ALL LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM PARTICIPATION IN THE EVENT BY YOU OR ANY REGISTERED PARTY. 
 
3. Limitation of Liability; Disclaimer of Warranties.
PADRE Foundation and DCES SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES, RESULTING FROM (A) THE USE OR THE INABILITY TO USE ACTIVE OR (B) FOR THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES OR (C) RESULTING FROM ANY GOODS OR SERVICES PURCHASED OR OBTAINED OR TRANSACTIONS ENTERED INTO THROUGH padrefoundation.org  OR (D) RESULTING FROM UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA,
 INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS, USE, DATA OR OTHER INTANGIBLE, EVEN IF PADRE HAS BEEN ADVISED OF THE POSSIBILITY OF  SUCH DAMAGES. YOU EXPRESSLY AGREE THAT USE OF ACTIVE IS AT YOUR SOLE RISK. ACTIVE IS PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. ACTIVE
EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT.
 
You understand and agree that any material and/or data downloaded or otherwise obtained through the use of the PADRE site is at your own discretion and risk and that you will be solely responsible for any damage to your own computer system or loss of data that results from the download of such material and/or data.
 
4. Indemnification. You agree to indemnify and hold each of PADRE Foundation and DCES harmless from and against any and all damages, costs, claims or demands, including reasonable attorneys' fees, made by any third party due to or arising from or relating to your use of the PADRE site.
 
5. Severability. You further expressly agree that this Agreement and Waiver is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any provision of this Agreement and Waiver shall be found to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and Waiver and shall not affect the validity and enforceability of any remaining provisions.
 
BY INDICATING YOUR ACCEPTANCE OF THIS AGREEEMENT AND WAIVER, YOU ARE AFFIRMING THAT YOU HAVE READ AND UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS.  YOU UNDERSTAND THAT YOU ARE GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE.  YOU ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

In consideration for my child and/or my own participation in this program offered by Diabetes Camping and Educational Services, Inc. (hereinafter referred to DCES) and Pediatrics-Adolescent Diabetes Research And Education (herein referred to as PADRE), I/we the undersigned, hereby agree to indemnify and hold harmless DCES and PADRE, its officers, agents, representatives, volunteers, and/or employees, from any loss and/or liability including expenses and costs, that may result from any death or injuries or damage to property that my child and/or myself may sustain while participating in any activity connected with DCES and/or PADRE, whether such death, injury or damage to property is caused by the passive or active negligent act or omission of DCES and/or PADRE, its officers, agents, representatives, volunteers, and/or employees or any other cause except intentional torts, fraud, or violation of law.  I agree that I will make no claim against DCES and/or PADRE, its officers, agents, representatives, volunteers, or employees for any injury or liability for which I have hereby indemnified DCES and/or PADRE. If any portion of this agreement is held to be invalid by a court of law, it is agreed that the remainder shall continue to be in full legal force and effect. Authorization is provided for the individual(s) listed as “emergency contact” to pick-up my child and authorize medical care, if necessary. 
Permission is given to DCES and PADRE to use my child and/or myself in any pictures, films, quotes, or videos of the program, which will promote or benefit the work of the organizations on behalf of those with diabetes. I further agree to assume responsibility for reasonable safety inspection of any grounds, structure of facilities at any location where I participate in the above program. I hereby represent that my child and/or I am physically able to participate in the above program. There are no refunds for failure to show, early departure, or dismissal from program.

You must be over 18 years of age OR the parent/legal guardian of a minor under 18 years of age OR the legal guardian of an incapacitated and/or mentally challenged person in order to agree to the text above.

Please enter your Date of Birth

Month

Day

Year

I agree to the above waivers.

Please enter your Signature

Participant's Information

First Name

Last Name

Gender

Date of Birth

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E-mail Address

Phone #

Street Address

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Parent/Guardian Name(s)

Parent/Guardian E-mail Address

Participant's Mobile Phone #

Do you have insulin-dependent diabetes?

If you attending with a friend, please provide their name

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