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Ohio District
Established 1918
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Kids Need Kiwanis
Aktion Club Registration
2025 Aktion Club Leadership & Education Day
"
*
" indicates required fields
Name of Person Registering
*
First
Last
Check one
*
Aktion Club Member
Aktion Club Advisor
Kiwanis Member
Circle K Member
Key Club Member
Caregiver
Guest
Email
*
Phone
*
Club Name
*
Dietary restrictions
Registration
Quantity
*
Price:
$35.00
Quantity
Names of Individuals Attending
*
# of Small Shirts
*
# of Medium Shirts
*
# of Large Shirts
*
# of X-Large Shirts
*
# of XX-Large Shirts
*
# of XXX-Large Shirts
*
The total number up shirts matches the total number of paid registrants (Aktion Club Members ONLY, not Caregivers)
*
Yes
Caregiver Registration
Quantity
*
Price:
$25.00
Quantity
This option is for caregivers only and does not include a t-shirt
Number of Turkey Sub Meals
See menu above for more info.
Number of Ham Sub Meals
See menu above for more info.
Number of Veggie Sub Meals
See menu above for more info.
The total number up meals matches the total number of paid registrants (Aktion Club Members and Caregivers)
*
Yes
Total
Coupon
How will you be paying?
*
Check
Credit Card
Purchase Order
Purchase Order Number
Credit Card
*
Card Details
Cardholder Name
Consent to Covid-19 Release of Liability and Assumption of Risk
I consent to the above and release Ohio District Kiwanis of any liability.
RELEASE OF LIABILITY AND ASSUMPTION OF RISK
The individual named in this registration form (referred to as “I” or “me”) are members of Ohio District Kiwanis & its affiliates (the “Company”) and desire to participate in-person at the Ohio Aktion Club Leadership & Education Day in Berea, OH (the “Activity”). As lawful consideration for being permitted by the Company to engage in the Activity, I agree to all the terms and conditions set forth in this agreement (this “Agreement”).
1. I am aware of the highly contagious nature of bacterial and viral diseases including but not limited to the 2019 novel coronavirus disease (COVID-19 (collectively, the “Disease”) and the risk that I may be exposed to or contract the Disease by engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including Company volunteers. I understand that while the Company has implemented preventative measures to reduce the spread of the Disease, the Company cannot guarantee that I will not become infected with the Disease or other infectious diseases while engaging in the Activity and that engaging in the Activity may increase my risk of contracting the Disease.
NOTWITHSTANDING THE RISKS ASSOCIATED WITH THE DISEASE, I ACKNOWLEDGE THAT I AM VOLUNTARILY CHOOSING TO ENGAGE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED. I EXPRESSLY ACKNOWLEDGE THAT I HAVE BEEN PROVIDED AN OPPORTUNITY TO ATTEND ALL MEETINGS VIRTUALLY, AND THAT I WILL NOT LOSE THE OPPORTUNITY TO VOTE OR VOICE MY OPINIONS IF I ATTEND THE MEETINGS VIRTUALLY. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF PERSONAL INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE RELATED TO THE DISEASE, ARISING FROM ENGAGING IN THE ACTIVITY, OR TRAVELING TO PARTICIPATE IN THE ACTIVITY WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR OTHERWISE.
2. I hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, employees, agents, affiliates, members, volunteers, successors, and assigns (collectively, “Releasees”), on account of injury, illness, disability, death, or property damage arising out of or attributable engaging in the Activity and being exposed to or contracting the Disease, whether arising out of the negligence of the Company or any Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.
3. I am familiar with federal, state, and local laws, orders, directives, and guidelines related to the Disease, including the Centers for Disease Control and Prevention (CDC) guidance on the Disease. I will comply with all such orders, directives, and guidelines while engaging in the Activity, including, without limitation, requirements related to hand sanitation, social distancing, and use of face coverings. I will also follow all instructions of the Company while engaging in the Activity I agree not to participate in the Activity if I am experiencing symptoms of the Disease, such as cough, shortness of breath, or fever, if I have a confirmed or suspected case of the Disease, or have come in contact in the last 14 days with a person who has been confirmed or suspected of having the Disease.
4. I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by/awarded against the Company or any other Releasees in a final judgment, arising out or resulting from any claim of a third party related to the Disease due to my engaging in the Activity.
5. By registering for this conference as an in-person attendee this constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me and our respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Ohio without giving effect to any choice or conflict of law provision or rule whether of the State of Ohio or any other jurisdiction.
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