Registration Form


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Online Registration

Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send us your registration. You will then be taken to the brochure page to select your trips.

Your Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone Number::	*
Emergency Phone Number::	*
Weight::	*
Height::	*
Emergency contact name::	*
Eye Color::	*
Hair Color::	*
Male or Female:	*
Which Pick Up / Drop Off Point will you use?:	*

Medical Section
Please fill out this section so we have it in case of emergency. This will ensure proper treatment. Please be as accurate as you can and you should update if there are any changes.

Any Food Allergies?: *
Any Medication Allergies?: *
Current Medications Taken?: *
List All Medical Concerns:: *
List All Behavioral Concerns:: *
How Do You Handle Them At Home?: *
Do You Use Any Adaptive Devices?: *
Type of Medical Insurance?:	*
ID Number?:	*

Field Trip Release Form
Release, Waiver of Liability and Covenant to Hold Harmless

The undersigned hereby acknowledges that participation in field trip activities involves inherent risks of physical injury, illness or loss of personal property and assumes all such risks.
The undersigned hereby agrees that for the sole consideration of Opportunity Village ARC allowing the undersigned to participate in “O-Ventures” field trip activities for which or in connection with which the Agency has sponsored or made available any equipment, facilities, transport, lodging, grounds or personnel for such programs or activities or to the undersigned while participating in any such field trip activities, the undersigned does hereby release and forever discharge Opportunity Village ARC and the Opportunity Foundation, its members individually, and its officers, agents and employees from any and All claims, demands, rights and causes of action of whatsoever kind of nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries including death, damage to or loss of property, and the consequences thereof, resulting from participation in or growing out of or connected with such “O-Ventures” field trip activities.

I understand that the acceptance of this release, Waiver of Liability and Covenant to Hold Harmless (not to sue) Opportunity Village shall not constitute a waiver, in whole or in part, of sovereign immunity by said Agency, its members, officers, agents and employees.

Participants Name::	*
Parent or Guardian (If under 18 or not Own Guardian):
Photo Release Do you consent to be photographed or to appear on film.:	*
Do you agree, understand and will abide by the conditions of this release?:	*
Date::	*

(Fields marked with * are required)