Traffick Jam On Registration
Date: August 4th, 2018
Times: 8:30am Registration
9:00am - 4:00pm Dance Workshop and Awareness Classes
6:00pm -7:30pm Dance Concert - Open to the public
Event Address: Memorial Hall 72 7th St, Racine, WI 53403
Contact us at (224) 944-2776 or info@fighttoendexploitation.org

*Anyone needing to leave prior to the end of the dance conference who is under the age of 18 will need to be signed out in person by a parent/guardian.

Email address *
Participant Name *
Your answer
Participant Phone Number (optional)
Your answer
Date of Birth *
MM
/
DD
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YYYY
Parent/Guardian Name
Your answer
Parent/Guardian Phone Number
Your answer
A limited number of scholarships are available on a case by case basis. Would you like us to contact you regarding that?
Group Name (if applicable)
Your answer
Which workshops are you interested in? (Pick 4) *
Required
There will be a dance performance in the evening by those who want to showcase a dance prepared for in advance. Will you be performing your own dance selection in the evening concert? Please check the appropriate boxes. *
Required
NOTE: Dance performances can be no longer than 2.5 minutes and must convey a message of empowerment, celebration of life, healing, or overcoming hardship. Only 10 dance pieces will be selected to perform due to time constraints.
Your answer
How many chaperones will attend with participant or group during the day, and what are their names? *
Your answer
How many Chaperones need a concert ticket? What are their names? ($10 each)
Your answer
How many additional concert tickets would you like to purchase?
FEE and the Traffick JAM ON are not registered allergists. If you have special needs as it relates to this area you are responsible for your own care. FEE and the Traffick JAM ON will not be held responsible for reactions based on allergies. ***I have read the above statement concerning allergies (Parent or Guardian - Print your name below to acknowledge this statement) *
Your answer
Emergency Authorization: I give permission for my child to attend the 2018 FEE Traffick JAM ON in Racine, WI. In the event that I cannot be reached in an emergency, I hereby give permission for the leadership of FEE and/or The Traffick JAM ON personnel to have an authorized doctor or medical professional hospitalize, administer medical aid and treatments, order injections, anesthesia or surgery for my child at any time they believe an emergency exists. I will be responsible for all medical bills. I agree not to hold FEE, The Traffick JAM ON, or it’s leaders responsible for any accident should it occur. Photo Release: I also grant permission to FEE/The Traffick JAM ON the right to use, reproduce, and/or distribute photographs, films, and sound recordings of my child, without compensation or approval rights, for use in materials created for purposes of promoting the activities of FEE/The Traffick JAM ON. ***By typing your name below you confirm you have read and agree to the above release statement. *
Your answer
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