Night of Noise Registration AgreeBy completing this registration form for GLSEN Collier Night of Noise on Saturday, April 13th, 2024 at 5200 Crayton Road, Naples, FL 34103: (1) I understand this event is hosted by GLSEN Collier County and is not affiliated with Naples United Church of Christ or Collier County Public Schools. GLSEN Collier County is a nonprofit organization that works to provide a safe and inclusive environment for LGBTQ students. (2) I acknowledge that LGBTQ students have a right to see themselves reflected in our classrooms, in our curriculum, and in our leadership throughout our schools and community. (3) I recognize that transgender and gender-diverse students have a right to be who they are and openly embrace their identity in all aspects of their lives without fear of bullying and harassment.PLEASE AGREE TO THE STATEMENT ABOVE TO CONTINUE.Participant First Name *Participant Last Name *PronounsCurrent School *Grade Level *Grade9101112Email *Phone *Confirm *I attest that I am a student in grades 9-12 or the parent/guardian of a student in grades 9-12 and that all the information I have provided in this registration is accurate to the best of my knowledge.Permission to AttendNight of Noise 2023 | Saturday, April 13, 2024, from 7PM to 10PM | 5200 Crayton Road, Naples, FL 34103Rules of ConductGLSEN Collier County General Rules of ConductWhile 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 ConsentI 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 *Start signing your signature hereYour browser does not support e-Signature field.Date *Parent/Guardian Statement of ConsentIt 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 34103Parent/Guardian First and Last Name *Parent/Guardian Phone Number *Parent/Guardian Signature *Start signing your signature hereYour browser does not support e-Signature field.Date *Medical Release Form with Emergency InformationGLSEN Collier Night of Noise | Saturday, April 13, 2024, from 7PM to 10PM | 5200 Crayton Road, Naples, FL 34103The 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 *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2012201120102009200820072006200520042003List any known allergies, including foodDoes this participant carry an EpiPen for emergency use *YesNoList any medical conditions or medications taken that we should be aware of:Emergency Contact Name *Relationship to Participant *Emergency Contact Phone Number *Parent/Guardian ConsentThis 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 *Start signing your signature hereYour browser does not support e-Signature field.Date *Submit