Member Information

Name:

Date of Birth:

School Name:

Grade:

Address:

Phone/Email:

Event Details

Event Date and Time:
[datetime-local event-datetime]

Location:

Description of Activities:
The event will include dancing, games, arts and crafts, and using glow-in-the-dark paint and toys under UV lights.

Acknowledgment of Risks

I acknowledge that participating in the Glow in the Dark event involves certain risks, including but not limited to physical activity, exposure to UV lights, and contact with glow-in-the-dark paint. I understand these risks and voluntarily choose to participate.

Medical Information

Emergency Contact Information:

Relation to the Member:

Medical Conditions:

Medication:

Allergies:

Please note that it is the parent/guardian’s responsibility to update Glow in the Dark for any change in address, medication, or allergies.

Consent to Participate

I understand that participation in the Glow in the Dark event is voluntary. I may withdraw from participation at any time without penalty.

Liability Waiver

I hereby waive, release, and discharge the organizers of the Glow in the Dark event from any and all claims, damages, or injuries that may arise from my participation in the event.

Photo and Video Release

I consent to the use of photos and videos taken during the event for promotional purposes.

Emergency Procedures

In case of an emergency, follow the instructions provided by event organizers and proceed to the nearest exit.

Contact Information

Please contact the event organizers at glowinthedarklowell@gmail.com for any questions, concerns, and feedback.

Signatures

Member’s Signature:

Date:

Parent/Guardian Signature (if applicable):

Date:

By consenting to participation, you agree to assume any risks associated with the activities of Glow In The Dark Lowell and understand that the organization is not liable for any injuries that may occur.