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Vine and Branches Membership Request

Vine and Branches Homeschool Co-op Connect with other homeschool families in NWI! Registration for Full Membership is now closed Associate membership is available any time! We are partners with South Shore Homeschool Athletics.
 

Used Curriculum Sale Registration & Agreement Form

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We are delighted you've chosen to be a part of the 2024 Vine and Branches Porter County Used Curriculum Sale on Thursday, May 23rd, 2024 at the First Baptist Church of Valparaiso!  We ask each participant to complete the following form in order to participate as a seller (if sharing a table, both participants need to complete the registration form).

The registration fee to participate as a seller is $10/table for Vine and Branches members (full and associate) and $15 for non-members. The deadline for payment and registration is May 9, 2024.  Space is limited to 33 tables so register now!

Payment directions for non-Vine and Branches members will have a Paypal link when you complete this form.

If you have questions, contact Tiffany O'Day at: tiffyoday@gmail.com or 219-688-4187.

 
1. *

Name of Participant:
2. *

Participant's Street Address:

 
3. *

Participant's City and Zip code:
4. *

Participant's Primary Phone Number (XXX-XXX-XXXX):
5. *

Do you receive texting on the telephone number that you provided above?

 (1 required)
YES NO
6. *

Participant's Email Address:
7. *

How many tables are you requesting?

 (1 required)
one two
three
8. *

Will you be sharing a table with a friend?

 (1 required)
yes no
9. 

If yes, with whom will you be sharing a table? (please be sure that person knows they'll need to fill out their own registration form online as well!)
10. *

Name of Emergency Contact:
11. *

Emergency Contact Phone Number (XXX-XXX-XXXX)
12. *

Is the Participant covered by medical insurance?

 (1 required)
yes no
13. *

If yes, list Name of Policy Holder; if no, respond n/a
14. *

Policy Group Number:
15. *

Name of Insurer:
16. *

I acknowledge that participation in activities sponsored by Vine and Branches (V&B), Porter County may involve risk to the Participants listed above (and to Participant’s parents or guardians if participant is a minor)and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. I authorize the V&B leadership to approve any medical treatment they deem necessary.

In consideration for the opportunity to participate in the V&B, Porter County Used Curriculum Sale, the Participant acknowledges and accepts the risks of injury associated with participation in this activity.  The Participant accepts personal financial responsibility for any injury, damage to property, or other loss sustained during the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, volunteers, or other representatives (collectively referred to hereinafter as the “Activity Sponsor”).  Further, the Participant releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.

I further grant Vine and Branches of Porter County the right to, without reservation or limitation, to capture the image of the Participant in photos or video and I hereby voluntarily and without compensation grant Vine and Branches of Porter County and its affiliated organizations involved in the activity permission to use the photographic/video image(s) taken of me, or of anyone listed above for whom I have legal responsibility for any publication, presentation, exhibit, video, or other print or digital format for Vine and Branches of Porter County purposes.

If a dispute over this agreement or any claim for damages arises, the Participant agrees to resolve the matter through a mutually acceptable alternative dispute resolution process.  If the Participant and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

I acknowledge that if anyone is hurt or property is damaged during my participation in a Vine and Branches of Porter County activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Vine and Branches of Porter County and First Baptist Church of Valparaiso on the basis of any claim from which I have released them herein.  I have had sufficient opportunity to read this entire document.  I understand this Agreement and I voluntarily agree to be bound by its terms.

I agree to all the terms listed in this Participation and Media Release.

 

 (1 required)
yes no
17. *

I understand there is a registration fee per table of $10 for Vine and Branch members (Full and Associate) and a $15 per table for non-members that is due on or before May 9, 2024.  I understand payments submitted after May 9, 2024 will not be accepted and my registration will be cancelled at that time if payment has not been made. 

 (1 required)
yes, I understand no, I do not wish to register after all
18. *

I affirm that all information provided on this form is true and valid.

 (1 required)
yes no
19. *

I willingly accept the terms of this agreement by signing my name electronically below.