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Fill this out if you are attending SLU 101 the week of June 23-26, 2021.

Student Leadership University (SLU) is honored to have you participate in one of our incredible experiences. As you join us, we need to let you know a few things, and we ask that you fill out this form before you or your child joins us. This form must be submitted in order to participate in SLU 101. 

 

This form is required to be filled out in its entirety 45 days before the event. 

LIABILITY WAIVER

The undersigned desires to participate in various programs, events, and activities (hereinafter collectively referred to as "Activities") operated by Student Leadership University. The undersigned further understands and acknowledges that you understand that there is always a possibility of injury or physical harm while participating in such activities. Before you or your student can join SLU in one of these amazing experiences, you agree that Student Leadership University cannot let anyone participate in any activities without releasing and holding harmless Student Leadership University. Further, the undersigned agrees to hereby release, and forever discharge Student Leadership University, their officers and directors, and their employees, their agents, and any parties volunteering on behalf of Student Leadership University for all actions, claims, damages, costs, expenses or damages of any kind growing out of or related to any activity of Student Leadership University in which the undersigned participates. You further acknowledge that this is a full and complete release for all injuries and damages which may be sustained as a result of participating in any Student Leadership University program. 

I Agree

COVID-19 Acknowledgement

If participating in a live in-person event with Student Leadership University in 2020-2021, you acknowledge an inherent risk of exposure to COVID-19 exists in any public place where people are present. You also acknowledge your voluntary compliance with all COVID-19 event precautions as outlined in pre-event communication and that you are participating in this event at your choice and in full awareness of the current progression of this global pandemic. You further acknowledge your responsibility in making a wise decision on whether to attend this event – and that you cannot attend if you have been running a fever of over 100.4, exhibiting systems of COVID-19, or been exposed to someone with COVID-19 in the 14 days prior to the event.

I Agree

PHOTO RELEASE

By registering you or your child an SLU experience, you give Student Leadership University permission to use photography, video, and audio that you or your child is in for any publication related to telling others about their experience with an SLU program. You give permission to Student Leadership University to use such images in connection with any publication including but not limited to brochures, booklets, videotapes, reports, websites, including social media, and exhibits, to use and cite any comment(s), verbal or written, made by you or your child about the program, and to use you or your child’s name in connections with any publication and in such manner as determined by SLU without compensation. If you would prefer we not take photographs or video, please notify us via e-mail.

I Agree

ACKNOWLEDGEMENT

I acknowledge I have read the above authorization, release, and agreement, prior to its execution, and that I am fully familiar with the contents of it. This release shall be binding upon the minor and me and our respective legal representatives. SLU and its partners will protect your information but may use it for promotional purposes.

I Agree

Please select who will be attending...
AdultMinor
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First Attendee's Name

First Name*

Last Name*

Phone*
First Attendee's Date of Birth*
First Attendee's Information

Year of High School Graduation (students only)

Attendee Email: *
Which of the following best describes the attendee?*
Student
Youth Pastor
Youth Volunteer
Parent
Educator
First Attendee's Signature*
Attendee's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Who are you attending with?
I am attending with...*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Year of High School Graduation (students only)

Attendee Email: *
Which of the following best describes the attendee?*
Student
Youth Pastor
Youth Volunteer
Parent
Educator
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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