PLEASE NOTE! The age of majority in Alabama is 19 (not 18). The information below is required for my records; 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:
Child's or Parent's E-Mail Address:
(so I can email the child or parent the confirmation flyer)
Age:
Date of Birth:
Address:
City:
State:
Zip:
Phone:
Any allergies or medical problems we should know about?
PARENT OR LEGAL GUARDIAN'S INFO:
Mother's Name:
E-Mail Address::
Father's Name:
E-Mail Address:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
ACCOMPANYING PERSON'S INFO (Person(s) authorized to take your child(ren) to FallFling):
Accompanying Person's Name:
E-Mail Address:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
GENERAL WAIVER AND INFORMED CONSENT TO PARTICIPATE
I, __________________________________ (legal name), parent or legal guardian of ___________________________________ (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 2018, held October 11-14, 2018, at Roxanna, 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 Roxanna, 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: