Please enter your information for our Tidal 21 event.

Type of Registrant:
PaddlerSupport

Name (required)

Age

Address (required)

City, State, Zip (required)

Your Email

Phone (required)

Emergency Contact Name (required)

Emergency Contact Phone (required)

Any allergies?
YesNo

Provide allergy details and any other medical conditions

Group Affiliation

Are you bringing your own boat?
YesNo

If so, please list for us the type of boat, length, width and capacity.

If you are registering as Support, please tell us - are you a first responder, lifeguard or other first aid?

Photo usage disclosure:

Yes, I give Marsh View Bible camp permission to use pictures in the following but not limited to Facebook Page, website, future applications, or slideshow.No, I do not give Marsh View Bible camp permission to use pictures in the following but not limited to Facebook Page, website, future applications, or slideshow.

COVID-19 Liability Release Waiver:

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Marshview Bible Camp adheres to comply.
We will TAKE ALL REASONABLE PRECAUTIONS.
In consideration of your participation at Marshview Bible Camp's Tidal 2021, please acknowledge the following:
You are aware of the existence of the risk on your physical appearance at camp and your participation in the activities at Tidal 2021 that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
That you have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.
No one within your household has visited any area within the United States that was reported to be highly affected by COVID-19 virus within the last 30 days.
You, nor any member of your household have been diagnosed to be infected of COVID-19 virus within the last 30 days.

Digital Acknowledgement of COVID-19 Waiver:

Following the pronouncements above, I hereby declare the following:

I fully understand the risk of contracting COVID-19.
With full knowledge of the risks involved, I hereby release, waive, discharge Marshview Bible Camp, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly, or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
I agree to indemnify, defend, and hold harmless Marshview Bible Camp from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

Digital Acknowledgement of COVID-19 Declaration:

*I understand and agree to wear a lifejacket while on or in the water at all times.
*I understand and agree to enter the water at my own risk only. There will be no lifeguards on duty.

Digital Signature - By typing your name you agree to the guidelines and agree that the information provided is factual and accurate as far as you know.

Date: