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Used Curriculum Sale Registration & Agreement Form

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We are delighted you've chosen to be a part of the 2021 Vine and Branches Porter County Used Curriculum Sale on June 15, 2021 at Liberty Bible Church!  We ask each participant to complete the following form in order to participate as a seller and ask that you adhere to all safety standard requirements provided to keep our families safe.  

The registration fee to participate as a seller is $10/table for Vine and Branches members and $12 for non-members; the deadline for payment and registration is June 8, 2021.  Payment directions for non-Vine and Branches members will appear in a message after completing the following form.  

If you have questions, contact Meredith Snyder at: [email protected]

 

1. *

Name of Participant:

2. *

Participant's Address:

3. *

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

4. *

Participant's Email Address:

5. *

How many tables are you requesting?

 (1 required)
one two
three
6. *

Will you be sharing a table with a friend?

 (1 required)
yes no
7. 

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!)

8. *

Name of Emergency Contact:

9. *

Emergency Contact Phone Number (XXX-XXX-XXXX)

10. *

Is the Participant covered by medical insurance?

 (1 required)
yes no
11. *

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

12. *

Policy Group Number:

13. *

Name of Insurer:

14. *

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 activities.  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 V&B, 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 V&B, 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 V&B 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 V&B, Porter County activity, I may be found by a court of law to have waived my right to maintain a lawsuit against V&B Porter County and Liberty Bible Church 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 Partcipation and Media Release.

 

 (1 required)
yes no
15. *

To ensure the safety of others involved in this event, I agree to all COVID-19 safety requirements set-forth by the event organizer.

 (1 required)
yes no
16. *

I understand there is a registration fee of $10 for V&B members and $12 for non-members to participate as a seller that is due on or before June 8, 2021.  I understand payments submitted after June 8, 2021 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
17. *

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

 (1 required)
yes no
18. *

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