Night of Noise Registration

COMPLETE THE REGISTRATION BELOW

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 2025 | Saturday, March 28, 2026, from 7PM to 10PM | Bonita Shores Club, 315 West Ave. Bonita Springs

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 Saturday, March 28, 2026, at Bonita Shores Club, 315 West Ave. Bonita Springs, Fla.

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 March 28, 2026, at Bonita Shores Club, 315 West Ave. Bonita Springs.

Parent/Guardian First and Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Signature *

Date *

Medical Release Form with Emergency Information

Night of Noise 2025 | Saturday, March 28, 2026, from 7PM to 10PM | Bonita Shores Club, 315 West Ave. Bonita Springs

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 March 28, 2026, at Bonita Shores Club, 315 West Ave. Bonita Springs, Fla., 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 *