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Joyful Journeys Event Participation form
* Indicates required question
Email
*
Record my email address with my response
Event Name
*
Your answer
Event Date:
*
MM
/
DD
/
YYYY
Event Location
*
Your answer
Full Name
*
Your answer
To Celebrate you may we have your Birthday
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other
Required
Phone number
*
Your answer
Email Address
*
Your answer
Would you like to receive our newsletter to stay current on upcoming events?
Yes
No
Clear selection
Street Address
*
Your answer
City, State and Zip
*
Your answer
Name of Legal Guardian (if under 18)
*
Your answer
Relationship to Participant:
*
Your answer
Guardian Contact Number (if under 18)
*
Your answer
Name and Phone number of Secondary Emergency Contact:
*
Your answer
Relationship to Participant
*
Your answer
Do you have any allergies, medical conditions or special needs?
*
Yes
No
Required
If "Yes" to the above section please explain.
Your answer
Will you need medication during this event?
*
Yes
No
Maybe
Participation Type
*
Choose
Youth Participant
Youth Volunteer
Parent/Guardian of Participant
Staff/Program Leader
Liability and Media Release:
*
I acknowledge that participation in Joyful Journeys events involves risks. I release Joyful Journeys, its staff, volunteers, and affiliates from any liability in the event of injury or illness.
I give permission for photos/videos of myself or my child to be used by Joyful Journeys for the promotional or educational purposes.
Required
Name of person completing form:
*
Your answer
Today's date:
*
MM
/
DD
/
YYYY
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