Mighty Ladies Member Form

Member Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Parents

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Parents

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Member Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

By Clicking on Submit below - I represents that all information provided is correct to the best of my knowledge and that I will abide by the Mighty Ladies Inc Rules Acknowledgement and Consent: I understand the conditions under which the Mighty Ladies in Nebraska. Staff supervision will be provided for children under the age of 17 years of age. For both internal and external use I acknowledge that the Mighty Ladies Inc. may utilize photographs or videos of my child that may be taken during involvement in the Organization activities. I consent to such uses and hereby waive any rights of compensation. Mighty Ladies Inc. also has my permission to obtain school records such as report cards, benchmark scores, and progress reports etc. that will help the club personnel to assist my child academically if the need arises. My child has permission to participate in classroom discussions which teach youth the dangers of drugs alcohol life skills/options and negative peer pressure. I understand that the events, classes and workshops are for the members only. Waiver of Liability & Disclaimer: In consideration of my child's membership and any participation in the activities and special programs or events of the organization on behalf of me and my child and any heirs or assigns of me or my child waive release and agree to defend and hold harmless the Mighty Ladies Inc. and its sponsors staff members board of directors and any other affiliated persons and/or vehicle drivers from any and all claims injuries death damages and demands arising or in any way resulting from or connected to any Organization-related event activity program or property. I attest and verify that I have full knowledge of the risks involved in Organization-related events activities programs and properties and that I will on behalf of the my child Emergency Authorization: I the undersigned as parent/guardian of my child hereby authorize the staff of the Organization its sponsors and vehicle drivers as my agents to consent to medical surgical dental examination or treatment of my child. In case of emergency I hereby authorize treatment or care at any hospital or by any licensed medical personnel. NOTE: BY CLICKING SUBMIT BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ AND ACCEPT THE POLICIES/CONDITIONS OF THE Mighty Ladies Inc. AS DESCRIBED ABOVE. Mighty Ladies Rules 1. Members should sign in DAILY. 2. Members are expected to keep all areas of the Organization clean and neat. 3. Members will be held responsible for their behavior. 4. Members are permitted in designated areas only. 5. Respect yourself and others, do not use foul language and keep your body to *

Rules and Regulations

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