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Child Care Registration FormThe American College of GastroenterologyAnnual Scientific Meeting and Postgraduate CourseOctober 17–22, 2014 • The Pennsylvania Convention Center, Philadelphia, PAYour Name:First Name Middle Initial Last NameMailing Address:City/State/Zip/Country:Home Phone:Work Phone:Cell Phone:Email:Name/s of Child/Children:Age/s:Childcare will be provided at the Philadelphia Marriott Downtown, the Headquarters Hotel during ACG 2014.To take advantage of this specialservice, read and sign the GeneralRelease and Waiver below andmail or fax this form to:American College of Gastroenterology6400 Goldsboro Rd., Suite 200Bethesda, MD 20817-5842Ph: (301) 263-9000Fx: (301) 263-9025Half-daymorningHalf-dayafternoonFull dayPlease indicate the block(s) of time you will be reserving.Saturday,October 187:00 am –5:00 pmSunday,October 197:00 am –5:00 pmMonday,October 207:00 am –6:00 pmTuesday,October 217:00 am –6:15 pmWednesday,October 227:00 am –12:30 pmWe must receive the Reservation Form and the signed General Release and Waiver by September 24, 2014.GENERAL RELEASE AND WAIVERWe, the undersigned, in consideration of the services of care for our children during the ACG 2014 Postgraduate Course and Annual Meetingin Philadelphia, PA, from October 17-22, 2014, do hereby release and discharge forever the American College of Gastroenterology, thePhiladephia Marriott Downtown, contracted child care providers, corporations both known and unknown, from any and all claims, demands,damages, actions, causes or actions, or suits at law or inequity because of any matter, incident or thing done, omitted or suffered to be doneby anyone, which may hereafter arise from or out of our children’s presence at the children’s program at the Philadephia Marriott Downtown,October 17-22, 2014.Furthermore, we the undersigned do expressly stipulate and agree, in consideration for the aforesaid children’s hospitality center, to indemnifyand to hold the American College of Gastroenterology and the Philadephia Marriott Downtown, firms and corporations both known andunknown, forever harmless against loss from any and all further claims, demands, grievances and causes of actions of any kind whatsoeverthat may hereafter at any time be made or brought by our children and we hereby waive any and all rights of exemption under the laws of anystate or against such claims.In the event of any emergency, the American College of Gastroenterology and the Philadephia Marriott Downtown and their agents have ourpermission to administer first aid or obtain emergency medical treatment in our children’s best interest. We agree to pay all expenses incurreddue to an emergency involving our children.Printed Name (Parent/Guardian)Signature (Parent/Guardian)(In signing, I/we acknowledge and accept the General Release andWaiver printed above.)129For more information on ACG 2014 and to register, visit www.acgmeetings.gi.org.