A Night to Remember Prom: Student Host Registration 2022

May 22, 2022 | Please Fill out this form to be a student host for A Night to Remember Prom 2022. You will be paired with an Honored Guest to accompany them throughout the day/evening events. As a reminder, you must be between the ages of 15 and 22.

Thank you for volunteering as a student host to our Honored Guests. Our student host enjoy the day/evening activities as much as our honored guests. We appreciate you taking time out of your day in helping A Night to Remember a successful event.

Note: Please reach out to us at ANTRPromMN@gmail.com if you can not register. We have maxed registration at 100. But if you are willing could use a few host alternatives in case of illness/covid day of the event. Thank you
Student Host Information

 
 
 
 
 
 
Please select one option.
 
 
 
 
 
Host Parent Info

If the host is under 18, the rest of this form will need to be filled out by a parent/guardian.
 
 
Release Form

PLEASE READ THROUGH the following HOLD HARMLESS AGREEMENT AND AGREE BY SIGNING THE STATEMENT BELOW. Questions can be directed to anighttorememberprommn@gmail.com
MINOR (>18) RELEASE AND HOLD HARMLESS

Event: A Night to Remember Prom 

Location: Rockwoods Event Center, Otesgo, MN

Date: May 22, 2022

 

I,                                      (name), am the parent or legal guardian of (the “Minor”), who desires to participate in various programs, events or activities (hereinafter collectively referred to as the “Activities”) operated or sponsored by A Night to Remember (hereinafter referred to as the “ANTR”) or on the property of ANTR. I understand and acknowledge that ANTR will not allow the Minor to participate in the Activities without releasing and holding ANTR harmless from any liability arising out of my participation in the Activities. I have investigated the risks involved in the Minor’s participation in the Activities and fully understand and assume such risks on his/her behalf. Specifically, I understand and acknowledge that the Minor may suffer or experience, among other things, personal injury or bodily damage, medical disabilities, and loss or theft of personal property. I REQUEST THAT ANTR ALLOW THE MINOR TO PARTICIPATE IN THE ACTIVITIES, AND IN CONSIDERATION THEREOF AGREE HEREBY TO RELEASE AND FOREVER DISCHARGE ANTR, ITS OFFICERS, BOARD AND DIRECTORS, AND ITS EMPLOYEES, AGENTS, AND ANY PARTIES VOLUNTEERING, FROM ALL ACTIONS, CAUSES OF ACTION, INJURIES, CLAIMS, DAMAGES, COSTS OR EXPENSES OF ANY KIND, INCLUDING ANY NEGLIGENCE OF ANTR, GROWING OUT OF OR RELATED TO THE ACTIVITIES (INCLUDING TRANSPORTATION TO AND FROM THE ACTIVITIES) IN WHICH THE MINOR PARTICIPATES. I UNDERSTAND THAT THIS IS A FULL AND COMPLETE RELEASE OF ALL INJURIES AND DAMAGES, WHICH THE MINOR MAY SUSTAIN AS A RESULT OF THE MINOR’S PARTICIPATION IN THE ACTIVITIES, REGARDLESS OF THE SPECIFIC CAUSE THEREOF. I acknowledge and agree that I have given my consent for the Minor to remain in the custody of ANTR representatives while participating in the Activities. This agreement is binding on my heirs, successors, and personal representatives.

 

PHOTOGRAPH & VIDEO CONSENT AND RELEASE – MINOR

 

In consideration of participating in the above-referenced Activities, I give A Night to Remember permission to use the minor’s name, likeness, image, voice, and/or appearance in pictures, photos, video recordings, audiotapes, digital images, and the like (collectively “material”), whenever taken or made for use in multimedia or printed presentations and used for display during services, events, or on A Night to Remember website, or incorporated in non-commercial or commercial products and services or A Night to Remember related products or services. I agree that A Night to Remember is they have complete ownership of such material including the entire copyright. These uses also include, but are not limited to, CD’s, exhibitions, videotapes, reprints, publications, advertisements, and other promotional, commercial, or educational materials in any medium including the Internet. I acknowledge that I or the Minor will not receive any compensation for the use of such material and hereby release A Night to Remember Prom, and its agents and assigns, from any and all claims that arise out of or are in any way connected with such use, including, without limitations, from any liability for violation of rights of privacy, publicity, defamation or any similar right.

 

 2022 MINOR- GENERAL RELEASE AND HOLD HARMLESS


Transportation, Event, Photograph and Video Release, Permission for Medical or Surgical Treatment and Power of Attorney

 

PERMISSION FOR MEDICAL OR SURGICAL TREATMENT AND POWER OF ATTORNEY

In the event the Minor suffers an injury or condition during his/her participation in the Activities, including transportation to and from the Activities, which may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if medical treatment is delayed, and reasonable attempts to contact me or the designated alternate contact person have been unsuccessful, to the extent allowed by local law, I hereby appoint the attending A Night to Remember Prom staff member or agent, as the Minor’s agent to act for them and in my name (in any way I could act in person) to make any and all decisions for the Minor concerning his/her personal care, medical treatment, hospitalization, and health care. This power of attorney and delegation of authority shall terminate when; the agent is able to contact the designated alternate contact person or me.


The undersigned agrees to the above sections and this agreement is binding on my heirs, successors, and personal representatives.


ADULT (18+) RELEASE AND HOLD HARMLESS

Event: A Night To Remember Prom

Location: STMA Middle School West, MN and STMA High School, MN.

Date: 5/22/2022

I, (the prom participant), desire to participate in various programs, events, or activities (hereinafter collectively referred to as the “Activities”) operated or sponsored by A Night to Remember Prom (hereinafter referred to as the “ANTR”). I understand and acknowledge that ANTR will not allow me to participate in the Activities without releasing and holding ANTR harmless from any liability arising out of my participation in the Activities including transportation to and from the Activities. I have investigated the risks involved in my participation in the Activities and fully understand and assume such risks. Specifically, I understand and acknowledge that I may suffer or experience, among other things, personal injury or bodily damage, medical disabilities, and loss or theft of personal property. I REQUEST THAT THE ANTR ALLOW THE ME TO PARTICIPATE IN THE ACTIVITIES, AND IN CONSIDERATION THEREOF AGREE HEREBY TO RELEASE AND FOREVER DISCHARGE ANTR, ITS OFFICERS AND DIRECTORS, AND ITS EMPLOYEES, AGENTS, AND ANY PARTIES VOLUNTEERING ON BEHALF OF ANTR, FROM ALL ACTIONS, CAUSES OF ACTION, INJURIES, CLAIMS, DAMAGES, COSTS OR EXPENSES OF ANY KIND, INCLUDING ANY NEGLIGENCE OF ANTR, GROWING OUT OF OR RELATED TO ANY SUCH ACTIVITIES (INCLUDING TRANSPORTATION TO AND FROM THE ACTIVITIES) IN WHICH I PARTICIPATE. I UNDERSTAND THAT THIS IS A FULL AND COMPLETE RELEASE OF ALL INJURIES AND DAMAGES, WHICH I MAY SUSTAIN AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES REGARDLESS OF THE SPECIFIC CAUSE THEREOF.

 

This agreement is binding on my heirs, successors, and personal representatives.

  

PHOTOGRAPH & VIDEO CONSENT AND RELEASE – ADULT

 

In consideration of participating in the above-referenced Activities, I give A Night to Remember Prom permission to use my name, likeness, image, voice, and/or appearance in pictures, photos, video recordings, audiotapes, digital images, and the like (collectively “material”), whenever taken or made for use in multi-media or printed presentations and used for display during services, events, or on A Night to Remember website, or incorporated in non-commercial or commercial products and services OR A Night to Remember related products or services. I agree that A Night to Remember Prom has complete ownership of such material including the entire copyright. These uses also include, but are not limited to, CD’s, exhibitions, videotapes, reprints, publications, advertisements, and other promotional, commercial, or educational materials in any medium including the Internet. I acknowledge that I will not receive any compensation for the use of such material and hereby release A Night to Remember Prom, and its agents and assigns, from any and all claims that arise out of or are in any way connected with such use, including, without limitation, from any liability for violation of rights of privacy, publicity, defamation or any similar right.

 

2022 ADULT- GENERAL RELEASE AND HOLD HARMLESS

Transportation, Event, Photograph and Video Release, Permission for Medical or Surgical Treatment and Power of Attorney


PERMISSION FOR MEDICAL OR SURGICAL TREATMENT AND POWER OF ATTORNEY


In the event I suffer an injury or condition during my participation in the Activities, including transportation to and from the Activities, which may endanger my life, cause disfigurement, physical impairment, or undue discomfort if medical treatment is delayed, and as a result of which I am unable, in the opinion of the attending physician to make an informed decision regarding such treatment, and reasonable attempts to contact my spouse or emergency contact person have been unsuccessful, to the extent allowed by local law, I hereby appoint the attending A Night to Remember Prom, Board,  staff person as my agent to act for me in my name (in any way I could act in person) to make any and all decisions for me concerning my personal care, medical treatment, hospitalization, and health care. This power of attorney shall terminate when, in the opinion of my attending physician, I am competent to make informed decisions regarding the need for medical treatment, or when the agent is able to contact my spouse or emergency contact person, whichever occurs first.

 

The undersigned agrees to the above sections and this agreement is binding on my heirs, successors, and personal representatives.

Understand that by signing below, you are confirming that you are 18+ and/or a Parent or Guardian of a Student Host of ANTR Prom. By signing below you're also confirming that a Night to Remember Prom, and its affiliates are removed from any and all liability due to injuries incurred before, during or after the tux fitting party, the dress shop, the prom event for any and all reasons including but not limited to negligence on behalf of A Night To Remember Prom Committee, weather, accidents or driving mishaps. I understand that my signature below constitutes a legal signature confirming that I acknowledge and agree to the above terms of acceptance.
 

Description

May 22, 2022
Please Fill out this form to be a student host for A Night to Remember Prom 2022. You will be paired with an Honored Guest to accompany them throughout the day/evening events. As a reminder, you must be between the ages of 15 and 22.

Thank you for volunteering as a student host to our Honored Guests. Our student host enjoy the day/evening activities as much as our honored guests. We appreciate you taking time out of your day in helping A Night to Remember a successful event.

Note: Please reach out to us at ANTRPromMN@gmail.com if you can not register. We have maxed registration at 100. But if you are willing could use a few host alternatives in case of illness/covid day of the event. Thank you