Chill Foundation Youth Program Registration

A group of youth in chill jersey's proudly hold up skateboards celebrating
STOP: This form is for legal guardians to register YOUTH PARTICIPANTS for programs. If you are an adult participant, please fill out the Agency Lead Form or Program Mentor Form. Thank you! 

1. Program Registration Information

The site where your youth is enrolled in program

2. Youth Information

example 01/18/1994

3. Youth Medical Information
Does this participant have any allergies, dietary restrictions, current health concerns, and/or behavioral, mental, or psychological conditions that may impact their time at Chill? If yes, briefly describe. If no, please put in NA or Not Applicable. 

4. Guardian and Emergency Information

General Sizing 
Chill and our Partners provide gear for youth and Agency Leads during programs . This includes all jackets, pants, gloves/mittens, skate pads, helmets, SUP gear etc (We’re sorry that you don’t get to keep it). We only ask for height and weight in order to set up the correct board for your participant. 

5. Media Waiver
I hereby irrevocably release, consent and allow The Chill Foundation and its Sponsors to use my/my dependent’s photographs/likeness/voice, as it pertains to participation with The Chill Foundation programs, in any manner for promotional efforts without expectation of any reimbursement in connection with its use. 

6. Universal Waiver




This Agreement is entered into by and between the undersigned (“the Undersigned”), the CHILL Foundation (including its respective affiliates, CHILL), and other parties including, but not limited to, host sites, event venues, sponsors, agencies, staff, volunteers, instructors and their respective affiliates (collectively, “Released Party” or “Released Parties).  Whereas, CHILL, in conjunction with the Released Parties, offers extraordinary boardsport programs for youth, in addition to annual fundraising events related to these programs, for the purposes of this Agreement known and referred to hereinafter as the CHILL Program (or the “Program”); and 

Whereas, the Undersigned is aware that despite supervision and instruction by CHILL Staff, instructors and other Released Parties, boardsports (snowboarding, surfing, skateboarding, paddle-boarding, wakeboarding) and related activities involve certain inherent risks, dangers and hazards that can result in personal injury and, in extreme cases, death. Further, the Undersigned is aware of the man-made, natural and environmental conditions, and other risks, which, independently or in combination with any boardsport activity, may cause or result in personal injury and, in extreme cases, death; and 

Whereas, the Undersigned acknowledges and agrees that participating in the CHILL Program and related activities may involve certain inherent risks, dangers, and hazards that can result in serious personal injury, illness or death. The Undersigned hereby freely agrees to assume and accept any, and all, known and unknown risks of injury which are in any way related to the participation in any of the events or activities associated with the Program, including but not limited to injury or death caused by other participants, volunteers, chaperones, spectators, or any other persons, environmental features, wildlife, water, weather conditions and the effects thereof, and other equipment of any kind located on or around the Program or activity. The Undersigned further acknowledges and agrees that the risk can be greatly reduced by participating within the Undersigned’s abilities and using common sense at all times; and 

Whereas, the Undersigned has voluntarily participated in the CHILL Program, and would like to participate in the CHILL Program despite all known and unknown risks of injury presented by participation in the CHILL Program; and  

Whereas, the Undersigned understands that THIS AGREEMENT IS A GENERAL RELEASE, COVENANT NOT TO SUE, AND WAIVER OF CLAIM AGREEMENT barring the Undersigned from bringing any claim for any reason for personal injury and/or death which is in any way related to participation in any of the CHILL Programs and the activities associated with the CHILL Programs, as well as boardsports; and  

Now, therefore, for the sole consideration of being permitted to participate in the CHILL Program, the Undersigned expressly and freely agrees as follows: 

1. TO ASSUME ALL INHERENT RISKS OF THE CHILL PROGRAM that are obvious and necessary and all other risks of property damage, personal injury, serious personal injury and/or death arising from boardsports and practicing for and/or participating in the CHILL Program. 

2. TO RELEASE FROM LIABILITY, COVENANT NOT TO SUE, DEFEND, AND HOLD HARMLESS CHILL, all Released Parties and their respective officers, agents, employees, directors, shareholders, representatives, affiliated entities, subsidiaries, and insurers, FOR ANY AND ALL LOSS, DAMAGE, INJURY, DEATH OR EXPENSE THE UNDERSIGNED MAY SUFFER OR INCUR, which may also result from any prizes or products that may be awarded to the Undersigned (nor shall any such prizes or products be warrantied or guaranteed by Chill to the Undersigned), or that the Undersigned’s next of kin may suffer or incur, as a result of the Undersigned’s practicing for or participation in the CHILL Program, and to WAIVE ANY AND ALL CLAIMS AGAINST THE RELEASED PARTY DUE TO ANY CAUSE WHATSOEVER, INCLUDING BUT NOT LIMITED TO, NEGLIGENCE DUE TO ANY CAUSE WHATSOEVER, BREACH OF CONTRACT, OR BREACH OF DUTY OF ANY KIND ON THE PART OF THE RELEASED PARTY and any entity or person performing any function with respect to the CHILL Program. 

3. EQUIPMENT.  To be responsible for the return, in good condition, of all equipment loaned to the Undersigned. 

4. CHOICE OF LAW/VENUEThis Agreement shall be governed by, enforced under and construed in accordance with the laws of the State of Vermont without regard to Vermonts conflicts of laws principlesThe parties hereby consent to the personal jurisdiction of the federal and state courts located within the State of Vermont, U.S.A. and agree that the venue for all disputes shall be resolved in the State of Vermont. 

5. SEVERABILITY.  If any term, provision, covenant, or condition of this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remainder of the provisions contained herein shall remain in full force and effect and shall in no way be affected, impaired or invalidated. 

6. BINDING EFFECT OF AGREEMENT.  In the event of the Undersigned’s death or incapacity, this Agreement shall be effective and binding upon the Undersigned’s heirs, next of kin, executors, administrators, assigns and representatives. 

7. MODEL RELEASE. That for the sole consideration of participating in the CHILL Program, the Undersigned authorizes CHILL to record and use materials incorporating the Undersigned’s name, audio and audio-visual recordings, or the Undersigned’s name and likeness, photographs, statements or testimonials of the Undersigned (collectively Images) in connection with marketing both the CHILL Program and certain products manufactured and/or distributed by CHILL. The Undersigned acknowledges and agrees that each Image is and will be deemed to be a work made for hire as defined in the U. S. Copyright Act of 1976, as amended, 17 U. S. C. 101, and will be exclusively owned by CHILL. If for any reason an Image is not deemed to be a work made for hire, the Undersigned hereby irrevocably assigns all right, title and interest in perpetuity worldwide in and to the Image, including the copyright and all other rights relating to the Image to CHILL. It is agreed and acknowledged that this Agreement confers on CHILL the exclusive right to display, exhibit, distribute, reproduce or authorize reproduction of the Images for all purposes, and to make derivative works, in any medium now known or later created. The Undersigned further waives all privacy, publicity, defamation, and proprietary rights related to the Images. CHILL may transfer or license its rights hereunder without the consent of the Undersigned. 

8. CERIFICATION OF INFORMATION AND CONSENT OF MEDICAL CARE FOR MINORS (if applicable): Health information provided to Chill for the below-named Participant is accurate. I agree to update Chill immediately with any changes to this information. If medical treatment is needed, I understand that the Agency is responsible for seeking medical treatment and notifying the Parents/Guardians of Participant. Participants and Agency Leads are responsible for the possession and administering of any/all medications as directed. Chill is not responsible for possessing/administering medications. I understand that the Agency will attempt to notify Parents/Guardians should medical treatment be sought, but not necessarily prior to the medical care being sought or rendered. 

You will be taken to an official signature page after you hit the 'submit button' for the above waiver.
Sorry, You must be 18 in order to sign our waiver and verify your participation in Chill.