Sacred Roots Registration Form

Sacred Roots Registration Form

You may fill out or send one form for your entire family, all related, living at one address, but please fill out separate forms for roommates or friends.

* = Required Fields

*Legal Name (& Nickname) (1):
*E-Mail Address (1):

*Are you joining us for feast? (Must register and pay by Sept. 4)
Yes
No

Legal Name (& Nickname) (2):
E-Mail Address (2):

Are you joining us for feast? (Must register and pay by Sept. 4)
Yes
No

*Address:
*City: *State: *Zip:

Home Phone:
Cell Phone:
Work Phone:

MINORS:

If you are bringing YOUR children with you who are under the age of 18, list their names and ages here. If YOU are the parent or legal guardian, there is no need to fill out a separate registration form for your children; but by listing their names here you are assuming responsibility for them while they are at the festival under the strictures of the waiver on the back of this page.

Full Name/Age:
Full Name/Age:
Full Name/Age:
Full Name/Age:

Will the children be having feast? (Must register and pay by Sept. 4)
Yes
No

If you are bringing children with you who are under the age of 18, and you are NOT the parent or legal guardian, please: a) list their names and ages below; b) have the parent or legal guardian fill out a Minor's Registration Form & Waiver for each child.

Full Name/Age:
Full Name/Age:
Full Name/Age:
Full Name/Age:

Any allergies or medical problems we should know about? (Please tell us *who* these conditions apply to!)

Dogs are allowed, but you must clean up after (curb) your dog! Each dog will be charged $15 admission fee.

Do you want to hold a class or ritual? Please fill out the Class Volunteer Form and send it in with your registration form and payment. NOTE: If you teach a class, you will be reimbursed $10 from your admission fee *after* the class is held, as our way of thanking the class teachers. :)

GENERAL WAIVER AND INFORMED CONSENT TO PARTICIPATE

*(1) I (Legal Name),
and (2) I (Legal Name),
having read and understood the rules and standards of conduct expected while at Dragon Hills, freely consent to these. Being a voluntary participant at Sacred Roots 2009, at Dragon Hills, Georgia, September 10-13, 2009, I agree to abide by the above rules and regulations. I also understand that if I do not abide by these, I may be escorted from the site without refund. I also agree to hold harmless the owners of the site of Dragon Hills, the organizers and staff of Sacred Roots, 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.

Please type your full legal name below; this will be your electronic signature)

*(1) Signature (parent sign for minor under 18 years of age)
*Date signed:

(2) Signature (parent sign for minor under 18 years of age)
Date signed:

Method of Payment:
I will be paying via PayPal momentarily
I will be mailing a check or money order
I will be paying at the gate

PLEASE PRINT A COPY OF THIS PAGE FOR YOUR RECORDS, *BEFORE* CLICKING THE SUBMIT BUTTON BELOW!!

When you click the button below, you will automatically be directed to the PayPal Payment Page. NOTE: If you just want to mail a check or money order, or pay at the gate, go ahead and click the button, but then simply ignore the PayPal page, and hit your Back button to come back to this page; if you want, you can print this page and mail with your payment to the address below (a good idea if you're paying for multiple things). Your registration information that you filled in above will be sent to me automatically.

If mailing this form with a check, please note below what you are paying for.
Prices per person:
Adult Admission without feast
$30.00
$________
Adult Admission *WITH* Feast (must be paid & registered by Sept. 4)
$40.00
$________
Child Admission Without Feast
$10.00
$________
Child Admission *WITH* Feast (must be paid & registered by Sept. 4)
$20.00
$________
Adult Day Trip Without Feast
$20.00
$________
Adult Day Trip *WITH* Feast (must be paid & registered by Sept. 4)
$30.00
$________
Dog Admission Fee (per dog)
$15.00
$________
Vendor Electricity Surcharge (only if using electricity, extra charge if arriving earlier than Thursday)
$25.00
$________

MAKE CHECKS OUT TO STEPHEN BRADFORD; mail form and check to:

Sacred Roots Festival
612 N. Slappey Blvd.
Albany, GA 31701