1. MILITARY FAMILY MONTH 2012
JOINT BASE LEWIS-MCCHORD FAMILY TREASURE HUNT
REGISTRATION FORM
Please complete and return registration and release of liability forms to the Family Resource
Center (FRC), Installation Volunteer Corps Office, FRC Bldg 4274, 9th Division & Idaho
Avenue, JBLM no later than 4:30 p.m., 31 October 2012
FAMILY NAME:______________________________________________________________
PARTICIPATING FAMILY MEMBERS (must list names and ages - individuals must be an
immediate family member)
Name Age
1.____________________________________ ___________________
2.____________________________________ ___________________
3.___________________________________ ___________________
4.____________________________________ ___________________
5.____________________________________ ___________________
ADDRESS: ___________________________________________________________________
CITY: ____________________________ STATE: _________ ZIP:___________________
PHONE: ____________________________ ALTERNATE: _________________________
E-MAIL ADDRESS**: _____________________________________________________
**Confirmation of receipt of your entry form will be sent to your email address.
SPONSOR’S UNIT: ____________________________________________________________
I agree to all terms outlined in the Joint Base Lewis-McChord Family Treasure Hunt Rules. I
also agree to be interviewed and/or have my picture taken for FRC websites and/or the
Northwest Guardian Newspaper use publicizing the event (not all participants will be asked
for interviews/photos).
__________________________________________ ______________________________
Adult Team Member Signature Date
__________________________________________ ______________________________
FRC Staff Member Signature Date Received
2. PLEASE ENSURE LIABILITY RELEASE FORM IS ATTACHED AND SIGNED.
RELEASE OF LIABILITY
Data Required by the Privacy Act of 1974
Prescribing Directive: 10 USC 2733, 28 USC 2671-2680, AR 27-20
Authority: Title 10, USC 3012. Principal Purposes: To release the United States Government, Department of the Army, I Corps and
Garrison Command, Joint Base Lewis-McChord, and the agents and employees thereof from any and all liability arising from or
incident to participation in the Joint Base Lewis-McChord Family Treasure Hunt.
Mandatory or Voluntary Disclosure and Effect on Individual Not Providing Information: Voluntary; however, if information is not
provided, participation in the Joint Base Lewis-McChord Family Treasure Hunt may be denied.
*********************************************************************************************
In consideration of the permission extended to me by the United States, through its agents, to
participate in the Joint Base Lewis-McChord Family Treasure Hunt, I
, and the below listed members of my immediate family, agree to release
and hold harmless the United States Government, the United States Army, Joint Base Lewis-McChord
and the agents and employees thereof from any and all liability for personal injury, death, property
damage or loss, or any other loss resulting from or arising out of my participation in the Joint Base Lewis-
McChord Family Treasure Hunt.
Participation in the Joint Base Lewis-McChord Family Treasure Hunt includes, but is not limited to
the risk of death or serious injury such as driving to/from various locations on Joint Base Lewis-McChord
and in the local area, or the conduct of other participants, including their negligence or willful misconduct.
I certify that I will abide by all safety rules and the direction of the Joint Base Lewis-McChord
Family Treasure Hunt coordinator. I further acknowledge that failure to abide by all safety rules and the
direction of the Family Resource Center staff may result in my being disqualified from participating in the
event and forfeiting eligibility for event prizes.
I also agree to release the United States and the United States Army, Joint Base Lewis-McChord
and the agents and employees thereof from any and all liabilities, claims, and causes of action, based on
or arising from negligence or gross negligence on the part of the United States Army, Joint Base Lewis-
McChord, and its agents and employees.
I acknowledge that I have read and understand the provisions of this release and understand that
it is binding upon myself and my assigns, heirs, executors, beneficiaries, family members, and derivative
claimants. I further acknowledge that I have no medical history or condition that would preclude me from
participating in the Joint Base Lewis-McChord Family Treasure Hunt.
Printed Name of Participant Date
Signature of Participant
*Participant listed above must be the parent/legal guardian of those family members listed below:
Printed Name of Family Member Participant Printed Name of Family Member Participant
Printed Name of Family Member Participant Printed Name of Family Member Participant
Printed Name of Family Member Participant Printed Name of Family Member Participant
This original signed two page registration form must be hand-carried to the Family Resource Center by deadline date.
