PLEASE SUBMIT THE FOLLOWING CONFIDENTIAL PAPERWORK

I.  TERMS AND CONDITIONS

Terms and Conditions: Emerge Conference is not responsible for problems beyond our control such as weather conditions, campus conditions, travel difficulties, health issues, etc). In the unlikely occurrence that our event has to be cancelled or postponed due to circumstances beyond the control of Emerge Conference, we will not be held responsible for any costs incurred by event attendees. There will be a photographer present at our event and by attending you give us permission to use any photos you appear in on our website or for marketing purposes. Emerge Conference does not accept responsibility and expressly excludes liability to the fullest extent permitted by law for: (1) any loss or damage to any personal property or (2) death or any personal injury suffered by attendees at the event. Authentic medical equipment will be used by attendees and proper use and care for these items is required.  STUDENTS WILL BE WORKING WITH NEEDLES AND SCALPELS.  THERE IS ALWAYS THE POTENTIAL THEY MAY INJURE THEMSELVES OR OTHERS.  IF YOU FEEL YOUR CHILD WILL SHOULD NOT BE A PART OF SIMULATIONS USING SHARP OBJECTS, PLEASE EMAIL US AND WE WILL MAKE A NOTE OF IT ON THEIR REGISTRATION.  Emerge Conference reserves the right to remove without refund any attendee whose behavior is dangerous, disruptive, reckless, and/or not conducive to a learning environment. Your non-refundable payment of $249 includes all conference fees, swag bag items, and a catered lunch. IT DOES NOT INCLUDE PARKING. Should you be unable to attend for any reason, you may TRANSFER your reservation to someone else, provided 1.) you email us your cancellation at emergetheconference@gmail.com and b.) your replacement registers online by June 1, 2018. After June 1, 2018, registration becomes NON-TRANSFERRABLE. By checking this box, attendees and their parent(s)/guardian(s) certify they have read, understood, and agree to these Terms of Service. 

☑️Agreed to & signed online previously at original checkout.

MEDICAL & LIABILITY RELEASE AGREEMENTS

I.  MEDICAL RELEASE AGREEMENT    

As the parent(s) / guardian(s) (“Undersigned”) of the below named attendee(s) (“Minor”), the undersigned are responsible for the health care decisions of the Minor and is/are authorized to give consent for medical treatment to be provided to the Minor.  The undersigned represents that no other consent from any other person(s) is/are required by law.

The Undersigned do hereby authorize Emerge Conference LLC (EC-LLC) as agents for the Undersigned, to consent to any x-ray examination, anesthesia, medical or surgical diagnosis or treatment and hospital care of the Minor, which is deemed advisable by and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the provisions of the California Medical Practice Act (Business & Professions Code Sections 2000-2029) and on the medical staff of a licensed hospital/medical center, whether such diagnosis or treatment is rendered at the office of said physician or said hospital/medical center.

It is understood and agreed that this authorization is given in advance of specific diagnosis, treatment or hospital care being required and is give to provide EC-LLC with the authority and power to give specific consent to any and all such diagnosis or treatment deemed advisable for the Minor.  This authorization is given pursuant to Sections 6910 and 6550 of the California Family Code and shall remained effective until December 31, 2018 unless revoked sooner in writing delivered to, and received by EC-LLC.

It is also understood and agreed that the Undersigned is/are responsible for all costs relating to the necessary medical treatment, whether through insurance or other means, and that EC-LLC does not provide medical insurance coverage and is not responsible for any costs relating to medical treatment of the Minor.

In addition to the above, the Undersigned agree(s) to allow the Minor to be photographed and/or videotaped for official publication purposes relating to EC-LLC (flyers, brochures, website, etc).

II.  LIABILITY RELEASE AGREEMENT

The Undersigned hereby release(s), waive(s), and discharge(s) EC-LLC, its officers, agents, employees and representatives (hereinafter “Releasees”) from any and all liability, responsibility, damages, losses, and claims resulting from personal injury, accidents, and/or property loss caused in any manner, including the simple, active or passive negligence of Releasees, arising from or related to Minor’s participation in EC-LLC activities.

The Undersigned further understand(s) and expressly agree(s) that the foregoing Medical Release Agreement and Liability Release Agreement (“Release Agreement”) is intended to be as broad and inclusive as is permitted by the laws of the State of California, including without limitation California Probated Code section 3500, et seq., and that if any portion of the Release Agreement is found invalid, it is agreed that the remaining provisions shall, notwithstanding, continue in full legal force and effect.

The Undersigned has/have carefully read this Release Agreement and fully understands its contents.  The Undersigned is/are aware that this is a release of liability and a consent to medical services, and further understand that the Undersigned is/are giving up substantial legal rights.  The Undersigned is/are not relying on any representation by EC-LLC which is not set forth herein, and further understand(s) that any modification to this Release Agreement must be made by EC-LLC in writing.  The Undersigned agree(s) to sign for the Minor listed on this form, and will update this form as information changes.

PLEASE FILL OUT CAREFULLY AND SUBMIT