Registration Form / Waiver The Reality Tour® is a national project of candle, Inc a non-profit organization
Download 14.87 Kb.
|
- Navigate this page:
- Tour begins at: 6:00 PM Latrobe Municipal Building
- Number of persons attending ______@ $5.00 per person = $_____________
LATROBE R E A L I T Y T O U R®
Registration Form / Waiver The Reality Tour® is a national project of CANDLE, Inc. a non-profit organization (www.RealityTour.org) Tour begins at: 6:00 PM Latrobe Municipal Building901 Jefferson Street Latrobe, PA 15650YWCA, 120ningham SSponsored by the Latrobe RotaryCheck the date that is your first choice. Put a “2” beside date that is your second choice2015 Sept 16th___________ Oct 21st Derry School_____ Nov 18th Derry School______ Dec 16th Ligonier School_______ 2016 Jan 20th Latrobe School____ Feb 17th_____ March 16th ____ April 20th _______ ___ IMPORTANT REGISTRATION INFORMATION: Your reservation will be confirmed! DO NOT ASSUME YOU ARE ACCEPTED FOR THE TOUR DATE REQUESTED UNTIL YOU RECEIVE CONFIRMATION by postcard, telephone, or email. Arrive promptly at 5:45 pm…Latrobe Municipal Building, Council Chambers. No refund for late arrival, no-shows or cancellations. The undersigned understands that the Reality Tour® includes the following scenarios: (Please circle if you wish to opt out of any portion of the tour) Peer Pressure Skit Emergency Room / Overdose Funeral Scene Arrest / Prison Surveys Some sections of the Reality Tour® may be emotionally disturbing and parental guidance is a must. I agree to allow my child/children _____________________________________________age/ages__________ to participate in the Reality Tour® and the self-reported survey data collection included in the program. To opt out of survey check here:___ I ______will (or) _____will not accompany my child on the tour. Parent or legal guardian must attend with any child under 18. If legal guardian, please name:______________________________________________________ I have read the above and agree not to hold CANDLE, Inc. or its affiliates liable for any claims, damages, demands, actions or lawsuits that could arise as a result of my participation or my minor child’s participation in the Reality Tour®. News photographers may be present at a Reality Tour®. ___________________________________ ______________________________________ ___________ Signature of parent or legal guardian Print name here Date Address: __________________________ City:_______________________ State___________ Zip__________ Phone # ________________ E-mail_____________________________________________________________ Please list names, ages & grade level of youth attending & include names of ADULTS attending as well: 1.______________________________ 3. ____________________________ 5.______________________ 2.______________________________ 4._____________________________ 6.______________________ Number of persons attending ______@ $5.00 per person = $_____________(No charge if free or reduced lunch)You may add a tax-deductible contribution to support The Reality Tour®.Donation amount = $_____________Total amount enclosed = $______________Make checks payable to: Latrobe Reality Tour 901 Jefferson Street Latrobe, PA 15650 724-396-0467 Latroberealitytour@gmail.com Reality Tour® is the property of CANDLE Inc. All rights reserved. June 2015 Directory: images -> documents documents -> The name has sometimes been derived from documents -> Guide to Preparedness documents -> Scidac scalable Data Management, Analysis, and Visualization Institute documents -> 1 Product Warranty 2 Manufacturing Procedures, Purchasing Controls and Materials Selection documents -> Amazon Prime’s Disruptive Impact on the Path to Purchase documents -> Table of contens documents -> Essentially pals documents -> New England Fishery Management Council 50 water street Download 14.87 Kb. Share with your friends:
|