Online Event Registration and Payment

B.L.A.S.T.

Building Leadership And Strengthening Teamwork

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B.L.A.S.T.
Building Leadership And Strengthening Teamwork
Camp John Hope FFA-FCCLA Center, Fort Valley GA
April 11-13, 2025

Cost: $129 per registrant
Registration Closes: 11:59pm on March 28, 2025

Please Note: * indicates a required field

Registration Information

Registration Discount Code

Demographic Information

Last Name *

First Name *

Middle Name

Name on Name Badge (enter name how you want it to appear)

E-Mail *

Address *

Address 2

City *

State *

ZIP Code *

Phone

Date of Birth *

Chapter *

Category *

Chaperone (note chaperone if Sweetheart, Rainbow Member, or Minor Female Guest was selected above)

T-Shirt Size *

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Alternate Phone

Medical Insurance/Health Information

All fields in this section are required. Check the "uninsured" box if you do not have medical insurance.

Uninsured?
check this box if you do not have medical insurance

Insurance Company *

Policy Holder Name *

Member ID# * (may also be called Subscriber ID or Policy ID)

Group ID# * (enter "none" if there is no Group ID)


Allergies * (list all known medication and food allergies; enter "none" if necessary)

Dietary Needs * (list any special dietary needs; enter "none" if necessary)

Medications * (list all current medications, including dose, frequency, and reason; enter "none" if necessary)

Health Problems * (list all known health conditions; enter "none" if necessary)

Terms and Conditions

Refund Requests
No refunds will be granted after March 28, 2025.

Prohibited Items
DeMolay Functions are drug, alcohol, and weapon free. Georgia DeMolay reserves the right to search any bag or room for cause. Registrants who are in possession of prohibited items will be removed from the event without refund.

Event Release
In the event of injury or illness to my son, daughter, or ward, I hereby authorize and direct DeMolay advisor(s) supervising the activity in which the above named youth is participating, to secure medical treatment, including, but not limited to, hospitalization, injections, anesthesia, and surgery for my son, daughter, or ward; thereby authorizing a supervising DeMolay advisor to sign and consent thereto as fully as I could were I personally present. I acknowledge that I will be responsible for payment of all charges related to the medical services provided. As parent or guardian of the registrant, I further agree to indemnify and hold harmless the Associated DeMolay Chapters of Georgia (aka Georgia DeMolay), and any adult advisors and/or volunteers who have agreed to supervise the activity for which my son, daughter, or ward is registering, from any damages recovered or recoverable by my son, daughter, or ward. Furthermore, I agree that, upon notification from an authorized adult DeMolay advisor or other volunteer assisting with the event at which my son, daughter, or ward is a participant, to remove my son, daughter, or ward, if, in the opinion of the supervising adults, it is deemed necessary and appropriate that he/she be removed from the activity site. I also agree on behalf of my son, daughter, or ward that, if it is deemed necessary by DeMolay advisors supervising the activity, his/her room may be entered and an inventory of his/her personal effects performed by no fewer than two DeMolay advisors. I assign and grant to the Associated DeMolay Chapters of Georgia (aka Georgia DeMolay) the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me and/or my son, daughter, or ward, and I hereby release the Associated DeMolay Chapters of Georgia (aka Georgia DeMolay) from any and all liability from such use and publication. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the Associated DeMolay Chapters of Georgia (aka Georgia DeMolay) and I specifically waive any right to any compensation I and/or my son, daughter, or ward may have for any of the foregoing. By allowing registrant to attend the event, I fully understand the above and agree to abide by its terms.

Electronic Signature

Instructions
If the registrant is under 18, the registrant's legal guardian must e-sign below.
If the registrant is 18 or older, the registrant must e-sign below.
Read the statement below and enter your name in the e-sign box to electronically sign your name.

"By entering my name below, I hereby state that I am over 18 years old and the legal guardian of the registrant listed above. I have read and agree to all of the above terms and conditions."

E-Sign *


Be sure to read all terms and e-sign above before clicking the "Continue" button.