2024 Hope Prom Guest Registration

Name

Name as you would like it to appear on name tag:

Date of Birth (Guests Must Be Aged 14 And Older)

Gender

Male Female

Address

This address will receive a confirmation email

Phone

Tshirt Size

Fun Fact about you:

Favorite Song

Likes/Dislikes

Emergency contact during event (will be listed on guest's name tag)

Emergency contact phone (will be listed on guest's name tag)

Related Health concerns:

Wheelchair/Accessibility Device dependent?

Special Communication needs?

If yes, please explain.

Sensory Issues/Concerns (strobe lights, camera flashes, loud noises, etc.):

Allergies: (Please list any that apply: foods, animals, latex, makeup, plants, pollen, and etc.)

Special food needs (cut-up, pureed, gluten free, etc.)

If Yes, please explain:

Will medication need to be administered during the event?

Please note that the church, their staff, and volunteers are NOT responsible for administering medication to guests during the Hope Prom event.
If medication is required during the event, a parent or caretaker MUST be available to administer the medication.

Will guest be dropped off and picked up by a parent/caretaker?

Will guest be taking public transportation to and from the event?

Will guest be attending as part of a group that will provide transportation?

Will guest like to be partnered with a buddy? (A buddy is a partner provided by Hope Church to stay with guest the entire night to assist with food, dancing, and any activities.)

Yes No

If yes, do they prefer: Male Female

Additional Notes/Concerns You Would Like Us To Be Aware Of

Parent/Caretaker Information

Parent/Caretaker Name(s):

Parent/Caretaker Phone:

Parent/Caretaker will be:

How many will be attending with our guest? (2 per guest are allowed)

Care Provider Agency - If Applicable

If attending as part of a group, please include agency or company name.

Care Provider Agency:

Care Provider Agency phone:

Name of Agency Chaperone (if applicable):

Note: Chaperone is not required to stay with guest(s) unless escorted by Care Provider Agency.

Additional Notes/Concerns:

Hope Church, Inc Liability Release Form

Event Name:
Hope Prom
October 5th, 2024

I understand that by initialing below, I assume any risk of harm or injury which may occur to the participant due to his/her/my participation in the event or activity. If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for Hope Church Inc, to seek emergency treatment for the minor, if necessary. I agree to accept financial responsibility for the costs related to any necessary emergency treatment. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Hope Church Inc, and its designated chaperones from any and all claims, demands, or causes of action,which are in any way connected with my (or my child’s) participation in these activities or use of Hope Church’s equipment and facilities. I acknowledge by signing this document, that if anyone is hurt or property is damaged during any participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the church, it's officers, and pastors OR its designated chaperones on the basis of any claim form which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself to the contents of this PARTICIPANT AUTHORIZATION, CONSENT AND RELEASE by reading it before I initialed it.

Initial here.

2024 Hope Prom Guest Registration

Description

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