Loading...

Fill this form out if you are registered for SLU 101 Reimagined, August 2-3, 2021. 

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

 

This form is required to be filled out in its entirety 30 days before the event. You will not have access to any SLU 101 event before this is completed.

LIABILITY WAIVER

By filling out this form, you acknowledge that you and/or your minor child will be participating and interacting with SLU through a virtual conference.  You acknowledge that part of this experience is interacting with SLU full time staff, SLU speakers, and SLU interns in monitored online discussion boards and chat rooms in a group setting.

Before you or your student can join SLU in this experience, you agree that Student Leadership University cannot let anyone participate in any activities without releasing and holding harmless Student Leadership University. Further, you and your child participating in this activity agree 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, 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 damages which may be sustained as a result of participating in any Student Leadership University program.

PHOTO & VIDEO RELEASE

By registering for 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 SLU. This is either through self-submitted images or written content through social media where SLU is tagged or hash-tagged or content obtained while participating in the conference itself. 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, press releases, 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.

ACKNOWLEDGEMENT

By submitting this form, 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.

I Agree

 

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

First Name*

Last Name*

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

Year of HS Graduation (students only)

Attendee Email: *
What organization are you attending with?*
Which of the following best describes the attendee?*
Student
Youth Pastor
Youth Leader
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.
Reference
Were you referred by another organization?*
No
Yes

If so, which organization?
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 HS Graduation (students only)

Attendee Email: *
What organization are you attending with?*
Which of the following best describes the attendee?*
Student
Youth Pastor
Youth Leader
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!