Great Cloth Diaper Change 2012 Registration Form

Thank you for pre-registering for the Great Cloth Diaper Change in Everett, Washington! Saturday, April 21, 2012 Silver Hall 11405 Silver Lake Road Everett, WA 98208 9:00am to 10:00am Your registration will enable us to have an accurate head count for Guinness and help us to plan activities and prizes! The first 25 Pre-registrants will be guaranteed a swag bag!
* Required

Photo Release

I, the undersigned, do hereby consent and agree that the Great Cloth Diaper ChangeSM hosts, organizers, Guinness World RecordsTM, and their employees, or agents have the right to take photographs, videotape, or digital recordings of me and my child on April 21, 2012 and to use these in any and all media, now or hereafter known, and exclusively for the purpose of publicizing and documenting the Great Cloth Diaper Change. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to the Great Cloth Diaper ChangeSM hosts, organizers, Guinness World RecordsTM, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

Liability Release

I also understand that the Great Cloth Diaper ChangeSM hosts, organizers, and Guinness World RecordsTM are not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

Please Keep in mind....

Space is limited. Please bring you and your diaper changee only. We will not be providing childcare for extra children. If you are bringing twins/triplets/octuplets ect, please make sure you have 1 registered adult per baby. Please be on time!! Most of all, have fun!

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