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Please print this form, fill it out completely,
sign & send SNAIL MAIL to:
Full Legal Name: _________________________________________ Magical Name: ___________________________________________ Address: __________________________________________________ City: ___________________________ State: _____ Zip: ________ Home Phone: _________________________ Work Phone: _________________________ E-mail: _______________________________ DOB: _________________ Sex: _________ (This is not a yes/no question. State your plumbing please. This information is necessary for gender specific events) Emergency Contact:
List any allergies or preexisting medical conditions
you have:
Your Experience
Do you have any experience in law enforcement? ____ If Yes, give
details:__________
Do you have any medical training? ____ If Yes, give details: _________________
Do you have any experience in the mental health field? ____ If
Yes, give details: _____
The information I have provided G.U.T.S is true and correct to the best of my knowledge. I understand that a representative from G.U.T.S. may contact one or more of the event organizers I have worked for in the past to verify details of my service. I understand that G.U.T.S. is providing a referral service only and that G.U.T.S. is not responsible for, or in control of, any member's actions. I, for myself and anyone entitled to act on my behalf, waive and release G.U.T.S., Out of the Dark inc., and all sponsors, their officers, representatives and successors from all claims and liabilities of any kind arising out of my participation in the Guardians United to Serve (G.U.T.S.) Network Printed Name: _____________________________________ Date: _________ Signature: _________________________________________ Date: _________ |