RM_StatsRegistration for Shine on the Main Line 2025Saturday, April 26th, 6:30 - 9:00 PM...Dress to Impress! Location: The Church of St. Monica Parish Center: 63 Main Ave, Berwyn, PA 19312 Plenty of free parking available!Each participant must register separately. If you are registering your family or registering on behalf of individuals in a group home, please fill out a registration form for each participant in your family/ each participant in the group home. Accompanying adult(s)/parents/ chaperone(s) do not have to pay a dance fee.Participant's First Name *Participant's Last Name *Participant's Age *Parent / Guardian Email *Parent / Guardian Cell Phone * Are you registering for a participant in a group home? * Yes No If Yes, Please List the Name of the Group Home I understand a responsible adult (18+) must accompany the participant for the duration of the dance * Yes, I understand Name of Adult Accompanying Participant * Waiver Information *I have read and agreeThe following items include: the General Release and Waiver, Photo Release, and Code of Conduct Agreement. All items must be checked in order to attend the All Abilities Shine on the Mail Line's Dance. All items, when checked, serve as your digital signature of agreement. The identified caregiver(s) staying onsite will also be asked to sign a release during check-in the night of the dance.Assumption of the Risk and Waiver of Liability *I have read and agreeBy checking this box, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to or infected by COVID-19 by attending the Foundation's events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Foundation's events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Foundation volunteers and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Foundation's events or participation in Foundation programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Foundation, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating there to. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Foundation, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Foundation program.Code of Conduct *I have read and agreeThe All Abilities Foundation of Greater Philadelphia’s focus is on inclusion, acceptance, and community without judgment. Our objective is to foster growth and development of all participating members of the dance. In participating in the dance, I understand that the event is not a drop-off program and that a parent, guardian, or other responsible adult must be present for the duration of the entire event. In addition, I pledge the following: To respect the volunteers working to make the dance successful for our participants. To respect and support all event participants regardless of ability. To show appreciation for the significant contributions of volunteers, parents, and others to the success of the event. To respect all facilities and equipment used in support of the event. Failure to adhere to these principles and guidelines may result in dismissal from the event. By checking the box associated with this statement, I acknowledge I have read the above statements, have discussed it with my child, and will abide by this Code of Conduct Agreement.Photo Release *I have read and agreeI consent and hereby grant the All Abilities Foundation of Greater Philadelphia and the Church of St. Monica and Assigns the right to take photographs of me or my child (or person for whom I am legal guardian) in connection with the Shine on the Main Line Dance 2025. I hereby grant the All Abilities Foundation of Greater Philadelphia permission to use my child’s or anyone identified in my group's likeness in a photograph in any and all of its publications including but not limited to all of its printed and digital publications. I understand and agree that any photograph using my child’s or anyone in my group's likeness will become property of the All Abilities Foundation of Greater Philadelphia and will not be returned. I hereby irrevocably authorize the All Abilities Foundation of Greater Philadelphia to edit, alter, copy, exhibit, publish, or distribute my photos for the purpose of publicizing its programs or for any other related, lawful purpose. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein these likenesses appear. Additionally, I waive any right to royalties or other compensation, financial or otherwise, arising or related to the use of the photograph. By agreeing to this release, I confirm that this consent has been explained to me in terms which I understand.General Release and Wavier *I have read and agreeI, as parent or guardian of the aforementioned child(ren), hereby give my approval for his or her participation in any and all of the activities of the Shine on the Main Line Dance 2025. I assume all risks and hazards incidental to the conduct of the activities at the event. I do further hereby release, absolve, and hold harmless the All Abilities Foundation of Greater Philadelphia, the Church of St. Monica, and all event volunteers. In case of injury to my son or daughter, I hereby waive all claims against the event organizers. I likewise hold harmless the All Abilities Foundation of Greater Philadelphia for acts of negligence on the part of the organization's volunteers. I assume responsibility for all medical payments. In my absence, I hereby give permission for my child to be treated in the event of a medical emergency, by agreeing to this waiver, I confirm that this consent has been explained to me in terms which I understand.Today's Date * To pay the $25 dance fee click the submit button, you will be redirected to PayPal to submit payment for the dance fee and finish registration. * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
