Name *

First Name

Last Name

Gender *

Male

Female

Wheelchair/Accessibility Device Dependent *

Yes

No

Special Communication Needs *

Yes

No

Sensory Issues/Concerns *

Yes

No

Allergies *

Yes

No

Food Needs *

Please select all that apply. Select "Other" for additional food needs. If you have no food needs, please select "None".

None

Dairy Free

Gluten Free

Soy Free

Sugar Free

Vegan

Vegetarian

Mechanical Soft

Other

Will guest need medication administered during the event? *

Please note Calvary Chapel Eastside staff and volunteers are not responsible for administering medication to guests during the Summer Sizzle event. If medication is required during the event, a parent or caretaker MUST be available to administer the medication.

Yes

No

Parent/Caretaker Name *

First Name

Last Name

Parent/Caretaker Phone *

(###)

###

####

Parent/Caretaker Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Parent/Caretaker Name

First Name

Last Name

Additional Parent/Caretaker Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

By submitting my guest registration, and for the good and valuable consideration of participating in an event hosted by CALVARY CHAPEL EASTSIDE, I hereby give my full consent to Calvary Chapel Eastside (“CCE”), a Washington nonprofit corporation, to record, by writing, by video, photographic, or audio recording device, or by any other analog or digital means, my actions, physical likeness, biographical information, and/or voice. Additionally, I hereby grant to CCE, without royalty or other compensation now or in the future, all rights of every kind and character whatsoever, in perpetuity, in and to any and all such recordings, along with any additional recordings I might provide to CCE, and to any benefits inuring to CCE as a result of its use of any of the foregoing recordings. Among other things, CCE may, but is not required to, copy or reproduce the recording, edit or modify it, incorporate it into another work, display or broadcast it or any of the foregoing privately or publicly, and use or license it or any of the foregoing for use by others, all for the sole benefit and at the sole discretion of CCE, for the advancement of CCE’s exempt charitable purposes. All permissions granted herein extend to any successor or assign of CCE and bind me and my heirs, successors, and assigns. I hereby release and discharge and agree to hold harmless CCE, its directors, officers, employees, volunteers, and independent contractors from any and all claims or damages, including but not limited to defamation or violation of rights of privacy or publicity, arising from or associated with the recording or use of the recordings. This release shall be construed, interpreted, and governed in accordance with the laws of the State of Washington, and should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I am of full age and have the right to contract in my own name. *

Yes, I AGREE.