Night of Noise Registration

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PLEASE AGREE TO THE STATEMENT ABOVE TO CONTINUE.

Participant First Name *

Participant Last Name *

Pronouns

Current School *

Grade Level *

Email *

Phone *

Permission to Attend

Night of Noise 2023 | Saturday, April 13, 2024, from 7PM to 10PM | 5200 Crayton Road, Naples, FL 34103

Rules of Conduct

GLSEN Collier County General Rules of Conduct
While attending Night of Noise, participants agree to abide by the following rules:

Participants are asked to be respectful of all other participants and staff;
Participants are prohibited from using, possessing, or arriving under the influence of drugs or alcohol;
Participants agree not to engage in any illegal activity whatsoever;
Participants agree not to engage in any sexualized behavior (including inappropriate touching or comments);
Participants who leave the event site prior to the conclusion of the event will not be permitted to re-enter;
Participants will help ensure the safety of all participants by immediately alerting staff to any health or safety issues or any activities that violate the general rules or otherwise compromise the safety or well-being of any participant;
GLSEN Collier County reserves the right to request the removal of any attendee that fails to comply with these rules of conduct.

Participant Statement of Consent

I agree to abide by the GLSEN Collier County General Rules of Conduct provided above while attending Night of Noise on April 13, 2024 at 5200 Crayton Road, Naples, FL 34103. I understand that violation of this agreement may result in expulsion from the event.

Participant First and Last Name *

Participant Signature *

Date *

Parent/Guardian Statement of Consent

It is understood and agreed upon by the participant and parent/legal guardian that all participants will abide by the GLSEN Collier County General Rules of Conduct. I understand that violation of this agreement may result in expulsion from the event. I hereby give my consent for my child to attend Night of Noise on April 13, 2024, at 5200 Crayton Road, Naples, FL 34103

Parent/Guardian First and Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Signature *

Date *

Medical Release Form with Emergency Information

GLSEN Collier Night of Noise | Saturday, April 13, 2024, from 7PM to 10PM | 5200 Crayton Road, Naples, FL 34103

The following medical information about this participant is for the purpose of obtaining immediate medical attention if necessary and is to be completed by all participants and parent(s)/legal guardian(s) of participants younger than 18 years old. Please provide as much information as possible to ensure the health and safety of participants in attendance.

Participant's Legal Name *

Date of Birth *

Month

Day

Year

List any known allergies, including food

Does this participant carry an EpiPen for emergency use *YesNo

List any medical conditions or medications taken that we should be aware of:

Emergency Contact Name *

Relationship to Participant *

Emergency Contact Phone Number *

Parent/Guardian Consent

This certifies that the participant may participate in Night of Noise on April 13, 2024, held at 5200 Crayton Road, Naples, FL 34103 sanctioned by GLSEN, Inc. By signing below parent(s)/legal guardian(s) hereby agree to indemnify and hold harmless and forever release GLSEN, Inc. and its directors, officers, employees and agents against and from any and all claims and damages, suits and proceedings, medical expense or expense of every type, all or part thereof which arise out of or relate to any activities of the participant or GLSEN.
In the event of an emergency, GLSEN representatives are authorized to engage a licensed doctor to render medical services which may, in the sole discretion of the doctor, be necessary; GLSEN representatives are also authorized to take participants to the hospital if necessary and parent(s)/legal guardian(s) agree to pay all doctor, hospital and related bills.

Parent/Guardian Name *

Parent/Guardian Signature *

Date *