Registration Form / Waiver The Reality Tour® is a national project of candle, Inc a non-profit organization
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- Tour begins at: 6:00pm Location: Blairsville Community Center
- ___ November 16th 2016 ___ December 7th 2016 ___ January 18th 2017
  
Blairsville Reality Tour Registration Form / Waiver The Reality Tour® is a national project of CANDLE, Inc. a non-profit organization (www.RealityTour.org) Tour begins at: 6:00pm Location: Blairsville Community Center101 E North Ave., Blairsville,PA 15717W. Cunningham St., Butler, PaCheck the date that is your first choice. Put a “2” beside date that is second choice___ September 21st 2016 ___ October 19th 2016___ November 16th 2016 ___ December 7th 2016 ___ January 18th 2017___ February 15th 2017 ___March 15th 2017 ___April 19th 2017IMPORTANT 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 5:45pm 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 guardian must attend with any child under 18. If 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 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.______________________ Donations accepted but not required Make checks payable to: Blairsville Support Group Against DrugsReality Tour® is the property of CANDLE Inc. All rights reserved. 1.70 2013 Directory: uploads uploads -> 587 Return function, r i(X) r i(0) r i(1) r i(2) r i(3) 1 0 2 4 6 Thermal Station, I 2 0 1 5 6 3 0 3 5 6 10 uploads -> Department of science and humanities department of mathematics part-a questions and answers uploads -> The Case Against the nypd’s Quota-Driven ‘Broken Windows’ Policing What Is It? uploads -> For want of a nail uploads -> Ownership Models There are two different types of ownership models uploads -> Police Militarization uploads -> City of rising star regular meting thursday, july 14, 2016 uploads -> Township of winfield uploads -> Stop Militarizing Law Enforcement Act of 2014 uploads -> The Black Panther Party’s Ten-Point Program What We Want Now! Download 12.11 Kb. Share with your friends:
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