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REGISTRATION FORM:


After completing the registration form:

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If you require assistance CALL: 1-877-212-8852

please enter complete address including postal code
Experience Date*
Your Zone Number*
Please enter name, phone number and address for your emergency contact.
Please enter name, phone number and address for your emergency contact.
Please enter name, phone number and address for your Physician.
Will you need to take scheduled medication during the event.*
Additional Assistance is Required*
Please detail the additional assistance that you will require. If you do not require additional assistance, please enter "does not apply".
I have reviewed the details of the event*
I am physically able to participate in the event*
I have considered inherent risk in participating in the event.*
I have read & understand the "STATEMENT OF CONDITION & WAIVER OF CLAIM".*
SCROLL DOWN THIS PAGE TO READ THE "STATEMENT OF CONDITIONS AND WAIVER OF CLAIM:.
I accept the terms of the 'STATEMENT OF CONDITION & WAIVER OF CLAIM".*
I have READ & UNDERSTAND the terms of the "LIABILITY RELEASE" for this event.*
I accept the terms of the "LIABILITY RELEASE".*
SCROLL DOWN THIS PAGE TO READ THE "LIABILITY RELEASE".
I have READ & UNDERSTAND the "MEDICAL TREATMENT CONSENT".*
SCROLL DOWN THIS PAGE TO READ THE "MEDICAL TREATMENT CONSENT".
I accept the terms of the "MEDICAL TREATMENT CONSENT".*
SCROLL DOWN THIS PAGE TO READ THE "MEDICAL TREATMENT CONSENT".
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Thank you! Your Registration is Complete. We will contact you within 24 hours to confirm that you have the necessary information and to discuss any questions that you may have.


STATEMENT OF CONDITIONS AND WAIVER OF CLAIM:

I understand and agree to the following:

Organizer = Eager Seniors and its Representatives

Participant = Individual Named on Registration Form

My electronic signature on the online registration acknowledges my understanding and acceptance of these terms.

The Organizer will not transport any Participant that appears to be intoxicated to or from the venue. In the event that a Participant appears to be intoxicated in the sole opinion of the Organizer, the Organizer will arrange alternate transport methods for the Participant, at the Participant's expense.

I understand that the group rates for each scheduled event are based on groups of 24 Participants. In the event that less than the required number of Participants have registered for any event, 48 hours prior to the event, the Organizer reserves the right to cancel the event. Payment will be returned to the Participant without penalty within 3 business days post the scheduled event.

I understand that pricing for transportation and event participation is based on group rates accordingly, refunds cannot be issued if registered Participant opts to cancel. In the case of serious acute medical conditions that require cancellation, each case will be reviewed independently. The Organizer will provide a decision within 5 business days of the cancellation.

LIABILITY RELEASE:

In consideration of the Organizer accepting the Participants Registration for an event, I/We do hereby release, forever discharge and agree to hold harmless the Organizer, its directors, employees, volunteers and agents from all liability, claims or demands for personal injury, sickness or death as well as the property damage and expenses, of any nature whatsoever which may be incurred by the Participant while engaging in transportation to the event, or while at the event. Furthermore, I/We do hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in the events.

MEDICAL TREATMENT CONSENT:

In the event of illness or injury, I authorize the Organizer to arrange transport to the nearest medical facility by ambulance or other suitable emergency vehicle.

In the event of illness of injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are necessary in the best judgment of attending [physicians or dentist and performed by or under the supervision of the medical staff of facility furnishing medical or dental services. I understand that I will be responsible for payment for any services, including but not limited to ambulances or emergency transportation that may be deemed necessary in the best judgment of the Organizer, emergency personnel and or attending physicians or dentists.

In the event of illness or injury the Organizer will attempt to contact my Physician, and Emergency Contact #1 &#2 as noted on my registration form. In the event that none of the named contacts can be reached, I/We authorize the Organizer to contact the closest emergency services for treatment or transport to any medical facility.

In the event of illness or injury or medical emergency experienced by any member of the group travelling to or from the venue, the Organizer will delay transportation to or from the venue until the medical situation has been alleviated, in the sole option of the Organizer. The Organizer will prioritize the medical situation while considering the safe and timely transport of Participants not directly involved by the medical situation. I/We understand that if I/We engage in hiring or the use of alternate transportation, I/We will be responsible for payment of the alternate transport arrangements.

In the event of illness or injury or medical emergency experienced by any member of the group travelling to an event, the Organizer will refund any portion of the fees paid that are deemed refundable to the Organizer by the transportation company or the venue. Refund is not guaranteed in all situations.

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