As a parent/guardian, chaperone, or friend/family member who will be part of a student group attending BOLT and who will be staying at the hotel as part of the group room package, please complete the following registration information . . . Choose the registration that is the best fit for you(Required) Chaperone Parent/Guardian Family Member/Friend/Companion What is the name of the student group you are accompanying (school, organization, etc.)?(Required) Name(Required) First Last Email(Required) Cell Phone(Required)Will you be staying in a hotel room that is included as part of the student group?(Required) Yes No (I will be booking and paying for my own hotel stay) Will anyone else be staying in the hotel room with you?(Required) Yes No Please list names and ages of anyone staying in the room with you(Required)Will you be attending the evening Epcot VIP special event with the student group?(Required) Yes No How many tickets do you need?(Required)Will you be using a Disney park-hopper pass arranged through the group to accompany students in a theme park in the evenings (after the BOLT program concludes each afternoon)?(Required) Yes No By registering and attending this event, you understand that at this event and/or related activities, you and/or your child/student may be photographed. As an attendee/participant in the event or activities, you agree to allow your and/or your child’s/student’s photo, video, or likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. Pegasus Springs Education Collective is a nonprofit organization. As part of the resort agreement for this event, Pegasus Springs Education Collective receives an $11 rebate for each room night at the hotel occupied and paid for by event coordinators and attendees at the group room rates during the dates of the designated room block. All funding from any rebate that is generated is used to offset expenses associated with offering this specific event to participants and attendees. By participating in the event, you consent for you and/or your child/student to receive medical treatment that may be deemed advisable in an emergency or in the event of injury, accident, and/or illness during this activity or event. You are aware that there is no health insurance coverage associated with this event or activities and that participants should carry their own health insurance. If medical treatment is needed as a result of participation in this activity or event, travel to and from the activity or event (including air travel), or any activity incidental to this event, you agree to be financially responsible for any costs incurred as a result of such treatment. By registering, you certify that you are voluntarily participating in this event and assume all risks for you, and/or your child/student, and/or anyone using a registration or ticket arranged by you to participate in this event. You are agreeing to release, indemnify, and hold harmless from any and all liability or claims the Pegasus Springs Education Collective and its partnering organizations — including their respective officers, directors, representatives, employees, contractors, coordinators, subcontractors, group leaders, volunteers, successors, assigns, insurers, and agents. Consent(Required) I am authorized to register as a parent or chaperone. I have read and agree to all terms and conditions, including the BOLT Terms & Conditions, the Walt Disney World Property Rules, and the Walt Disney Word Resort’s Terms & Conditions for Theme Park Reservations. Δ
