REGISTRATION FORM - World Youth Alliance

CityAdventure Registration Form 1of 2
REGISTRATION FORM
One person per registration form. Please print clearly, and complete the entire form as
applicable. Send completed form to:
World Youth Alliance, 228 East 71 st Street, New York, NY, 10021.
GENERAL INFORMATION
______________________________________________________________________________
First Name MI Last Name
______________________________________________________________________________
Address City State Zip Code
___________________ ______ Gender: M F
Date of Birth (mm/dd/yy)
Age
______________________ __________________________ _________________________
Home Phone Business Phone Cell Number
___________________________
E-mail Address
How did you hear about CityAdventure and/or the World Youth Alliance?
____________________________________________
REGISTRATION FEE
Please submit your non-refundable, non-transferable registration fee with this registration form. If you will mail this form, only
check payments will be accepted. If you will personally deliver this form to World Youth Alliance, check and cash payments will
be accepted. Checks must be made out to World Youth Alliance.
I am ______ a minor (below 18 years of age). ______ not a minor.
I am
______ a student, with a five dollar ($5) registration fee (please provide a photocopy of your school ID,
which should include your name, picture, and current academic year).
______ not a student, with a thirty-five dollar ($35) registration fee.
I am registering as
______ an individual, and would like to be arranged into a team.
______ a member of a team. My team and I are willing to accept other participants into our
team if we do not reach the required number of six (6) members per team.
The names of my teammates are: _________________________________
______________________________________________________
______________________________________________________
I wish to participate in CityAdventure. I understand that I am responsible for any and all transportation expenses incurred during
the event. Minors must register as part of a team that includes at least one (1) adult, parent and/or guardian, and must be
accompanied by the adult, parent and/or guardian at all times. I understand that the registration fee is non-refundable, nontransferable,
and not tax deductible.
* We strongly suggest purchasing a seven dollar ($7) 1-Day Fun Pass (Unlimited Ride MetroCard), considering its convenience
and economic advantages for the purposes of this event.

CityAdventure Registration Form 2of 2
WAIVER AND RELEASE OF LIABILITY (Please read and sign below.)
I understand that while participating in CityAdventure: A New York Expedition in—Dignity, Solidarity, Life, I will be using public streets and
facilities where many hazards exist and I am aware of and appreciate the risks that may result. I am also aware that accidents may occur
during this event which could result in serious injury or death. I am voluntarily participating in this event with knowledge and full
understanding of all such risks.
In consideration for being permitted to participate in this event, I agree to assume all risks and to release, hold harmless and covenant not to
sue World Youth Alliance, Artists Space, Rubin Museum of Art, Museum of the City of New York, National Dance Institute, Krystal’s Cafe and
any designated beneficiaries, sponsors, officials, participating clubs, communities, organizations, friends of the event, all other government or
public entities and affiliated organizations and all their respective directors, officers, agents, employees and members (collectively, “the
releasees”), for any claim, loss or liability that I may have arising out of my participation in the event, including personal injury, death or
property damage, whether caused by negligence or carelessness of the releasees or otherwise.
I hereby release in advance, and to waive my rights and to discharge all of the releasees from any and all claims, losses or liabilities for death,
personal injury or property damage that I may have, or which may hereafter accrue to me, as a result of my participation in this event, even
though that liability may arise from negligence or carelessness on the part of the releasees, from dangerous or defective property or equipment
owned, maintained or controlled by them or because of their possible liability without fault. I understand and agree that this Waiver and
Release of Liability is binding on my executors, administrators, heirs, next of kin, successors, assigns and legal representatives.
I am physically capable of completing this event. I understand that I may be asked to provide a doctor’s note or other proof that I am permitted
to participate by my primary health care provider. If I am aware of or under treatment for any physical infirmity, ailment or illness, my medical
care provider knows of and has approved my participation in this event. I will maintain personal health insurance while participating in the
event. I acknowledge that I, and I alone, am solely responsible for my personal health and safety, and the personal property I bring with me. I
will read the event description and rules for participation in the event and I will abide by all rules and regulations established by the event
organizers and personnel. I further agree that my participation in the event is subject to the sole discretion of the organizers of the event, and
that my participation may be limited for medical or other safety- related reasons.
I understand that my name, photograph, voice or likeness may be used for all promotional purposes related to the event by World Youth
Alliance, Artists Space, Rubin Museum of Art, Museum of the City of New York, National Dance Institute, Crystal’s Café, and any designated
sponsors, beneficiaries, licensees, affiliates and employees. I consent to and authorize, in advance, such use and waive all rights of privacy I
have in connection therewith, and I understand that I will not benefit financially from any use of thereof.
I have carefully read this Waiver and Release of Liability and fully understand its contents. I am aware that by signing this Waiver and Release
of Liability, I am waiving legal rights and knowing this, I sign it of my own free will.
_______________________________ _______________________________________ _______________________
Participant’s Printed Name Participant’s Signature (regardless of age) Date Signed
If participant is under 18 years of age, a parent or guardian must execute, in addition to the foregoing Waiver and Release
of Liability, the following, for and on behalf of the minor.
The undersigned parent and natural guardian or legal guardian of the applicant ________________________ (minor’s name) executes the
foregoing Waiver and Release of Liability for and on behalf of the minor named herein. I hereby bind myself, the minor and all other assigns to
the terms of the Waiver and Release of Liability. I represent that I have legal capacity and authority to act for and on behalf of the minor
named herein, and I agree to indemnify and hold harmless the releasees named in the Waiver and Release of Liability for any claims or
liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the
execution of the Waiver and Release of Liability. I also understand the rules and regulations established by the organizers of the event, and
have reviewed said materials with said minor regarding the stipulated conditions and ramifications. I fully consent to said minor’s participation
in this event.
I have carefully read this Waiver and Release of Liability and fully understand its contents. I am aware that this is a contract between myself
and the above mentioned releasees and I sign it of my own free will.
_______________________________ _______________________________________ _______________________
Parent/Guardian’s Printed Name Parent/Guardian’s Signature Date Signed