Event Name: ______________________________________________

Event Date: ____________________________

Event Location: __________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Event Site Emergency Phone Number: _________________________________

Directions to Event: _____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Sponsoring Organization: ________________________________

Sponsoring Organization's  Address: ________________________________
____________________________________________________________________________
____________________________________________________________________________

Event Director 's Full Legal Name: ______________________________________

Address: _________________________________________________________________

City: ___________________________  State: _____  Zip: _________

Home Phone: _________________________

Work Phone:  _________________________

E-mail:  ________________________________

DOB: _________________

Is this a gender specific event? ______  If yes, which sex? _________

Approximately how many attendees are you expecting at this event? _______

How many Guardians do you need? _______

Will your Guardians be responsible for emergency medical situations or do you have a separate medical staff? ____________________________________________

Can you pay gas and tolls for Guardians working your event? _______

Does your site allow staff to bring well trained companion animals? ______

The information I have provided G.U.T.S (Guardians United to Serve) is true and correct to the best of my knowledge.   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 as designated representative of this event's sponsoring organization, and anyone entitled to act on our 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: ___________