PLEASE NOTE! The information below is required for my records, so you may copy and paste it into an email for convenience and time, but an original signature from a parent or legal guardian is required for permission for a minor to attend, so please print out this form, and mail it in and/or send it with the child to FallFling.
CHILD'S INFO:
Legal Name (1):
Email:
Age:
Date of Birth:
Legal Name (2):
Email:
Age:
Date of Birth:
Address:
City, State, Zip
Home phone:
Any allergies or medical problems we should know about?:
PARENT OR LEGAL GUARDIAN'S INFO:
Mother's Name:
Email:
Father's Name:
Email:
Guardian's Name:
Email:
Address:
City, State, Zip
Home phone:
Other phone:
ACCOMPANYING PERSON'S INFO:
*Name of person(s) authorized to take your child(ren) to FallFling:
*E-Mail Address:
*Address:
*City, State, Zip
Home phone:
Other phone:
The cost: cheap!!
(NOTE: Current price only good if payment accompanies registration.) Prices per person:
| Only pay for one child age 11-17, at 1/2 price! All other kids are free! (Must be in immediate family, same address as registering adult) | ||
| Postmarked and paid by July 1, 2012 | $________ | |
| Postmarked and paid by August 15, 2012 | $________ | |
| Postmarked and paid by October 5, 2012 | $________ | |
| Thereafter | $________ | |
| Total enclosed: | $________ |
MAKE CHECKS OUT TO LINDA KERR
I, ____________________________ (print legal name), parent or legal guardian of
____________________________ (print child's legal name),
do give permission for my child to attend FallFling in the company of
____________________________ (legal name of person accompanying child).
I have read and understood the rules and standards of conduct
expected
while at FallFling 2012, held October 18-21, 2012, at Cherokee Farms, and agree
that my child will act within these rules. I also understand that if my child does not abide by
these, he/she may be escorted from the site without refund. I also agree to hold harmless the
owners of the site of Cherokee Farms, the organizers and staff of
FallFling, and all its representatives, from all claims, actions, expenses and demands in
respect
to
injury, loss or damage to my person or property, however caused, arising in connection with my
participation even if the same may have been contributed to or occasioned by the negligence of
the owners, the said body, or of any of its representatives.
Signature of parent or legal guardian
Date signed
Or snail-mail it to: