Family Membership Form

INSTRUCTIONS FOR FAMILY MEMBERSHIP FORM
This form is for families of up to 2 adults, and families with children (legal parents or guardians)and their dependent children. All children must be listed on this form regardless of age. A dependent child is from birth to under 18 or to age 25 if you are legally able to claim them on your tax return. All family members listed on this form must reside at the same address which is considered their main home.
If you have a special circumstance, such as, non custodial or split custody, please contact the Membership Coordinator and explain situation and get an exception.
When you have completed the form click submit at the bottom of the page and it will take you to the payment of membership dues.

Please fill out the form completely. All RED stars are required. If you have more than 8 children contact membership coordinator. Please read all instructions carefully. For 2 adults please fill in all Adult #2 spaces.

Northwest Civil War Council Family Membership Form 2018

Name of Adult #1 *

First

Last

Adult #1 Date of Birth *

Adult #1 Phone *

Email *

Adult #1 Please choose one *

Military Combatant Non Combatant or Civilian

Unit your family wishes to join *

Name of Adult #2 *

First

Last

Adult #2 Date of Birth *

Adult #2 Phone *

Adult #2 Email *

Adult #2 Please choose one *

Military Combatant Non Combatant or Civilian

Adult #2 Unit (if different than adult #1) *

Families Address *

Line 1

Line 2

City

State

Zip Code

Country

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Child's Name *

First

Last

Child's Date of Birth *

Combatant (YES or NO) *

Name of Child(ren)'s Physician *

Child(ren)'s Physician's Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

GENERAL RELEASE OF LIABILITY-------------------------- I am fully aware of the nature and purpose of the activities of the Northwest Civil War Council (NCWC). I agree to be bound by the bylaws, rules and policies of the NCWC and to obey the direction of the governing officials at all NCWC events. I acknowledge that reenacting, black powder shooting, and related activities are hazardous, and that I have made a voluntary choice to participate. I agree to assume any and all risks of injury or death that may result from my participation in NCWC events. I agree to release, waive, and discharge from all liability to myself or to any of my family members, and promise not to sue the NCWC, its governing officials, its board of directors, or the owner or lessor of any property on which the NCWC conducts activity, whether caused by those parties, negligence or any other reason, for any injuries which may result form preparing for, practicing for, traveling to or from ,or participating in any NCWC event. I agree to indemnify and hold harmless the parties release above and each of them from any loss, liability, damage or claim they may incur due to my actions during NCWC events, whether caused by their negligence or otherwise. I understand that the NCWC's insurance protects the NCWC, not me. Accordingly, if I injure someone or cause property damage while participating in an NCWC event, the fact that the NCWC has insurance will not prevent the injured party from seeking compensation directly from me. It is my intent that this release be as broad and inclusive as allowed by law, and that if any portion is invalid the remainder shall continue in full force and effect. This release is entered into solely for NCWC events and does not confer a release upon any parties for their actions when not acting in furtherance thereof. --------------------------------Adult #1 I have read, understand and freely agree to the General Release and all its terms.-------------------------Sign in box below *

Date *

Adult #2 Signature: I have read, understood and freely agree to General Liability Release and all its terms. *

Date *

PARENT/GUARDIAN AGREEMENT OF MINOR PARTICIPATION---------------------- I am the parent or guardian of the minor(s) listed above. I give my permission for the minor(s) to join and participate in NCWC events. I agree with and hereby sign on behalf of myself and of the minor(s), The General Release of Liability above. I or the sponsor am 18 years of age or older and either I am, or the sponsor is, an active member of the NCWC. The minor(s) belongs in my or the sponsor's unit. I or the sponsor agree to attend every event the minor(s) attends and be responsible for the actions of the minor. ---------------------------------------------------------------------------MEDICAL CONSENT BY PARENT OR LEGAL GUARDIAN OF MINOR CHILD---------------- I, being the parent or legal guardian having legal custody of the minor child listed above and below, authorize the performance of all medical, surgical, diagnostic and hospital care, procedures or treatment, which may be performed or prescribed for the minor child by a licensed physician or hospital, when reasonable efforts to timely contact me are unsuccessful and when such care or procedures are deemed immediately necessary or advisable by the physician to safeguard the minor child's health--------------------------------------------------As the parent or legal guardian of the minor child(ren) listed above, I have read, understand and freely agree to all terms and conditions the Minor Participation Agreement, The Medical Consent by Parent or Legal Guardian of Minor Child Agreement as well as The General Release of Liability agreement. My Signature below confirms this for each child.--------------1st Child's name in the box below then Signature and date and each subsequent for each child. *