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:
                         Name:_______________________________
                     Address:_______________________________
                                    _______________________________
                        Phone:_______________________________

List any allergies or preexisting medical conditions you have:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Why do you want to be a Guardian?________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Do you have or plan on getting any experience in law enforcement? ____ 
If Yes, give details:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Do you have or plan on getting any medical training? _____ 
If Yes, give details: 
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Do you have or plan on getting any experience in the mental health 
field? ____ If Yes, give details: 
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Have you every worked security or safety at a Pagan Event or Gathering?
It's ok if you haven't; if you have, please list them below:

Name of Event	Date	Event Organizer's Name	Their Contact Information	Your Position
1. .	.	.	.	.
2. .	.	.	.	.
3. .	.	.	.	.

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: ___________