Attendee's Name *

First Name

Last Name

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Phone Number *

(###)

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

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Will someone be accompanying your child to Promapalooza 2022? *

Due to limited space, attendees are permitted to bring one (1) guest.

Yes

No

I understand that parents are not permitted at Promapalooza 2022. *

Our goal is to make Promapalooza a typical & realistic prom experience. Therefore, Promapalooza is a 'parent-free zone'. It’s a time for our guests to have an independent, social & magical night with their peers! Additionally, we have limited space capacity and want to include more guests resulting in a fun night with peers. If you have any questions regarding this, please visit our FAQ page or email mia@projectinclusion.org.

Yes, I understand.

Does your child have a mobility impairment/physical disability? *

Yes

No

How would you describe the level of support your child needs throughout the event? *

Needs one-on-one support (Volunteer to stay with them the entire night)

Needs minor support (Volunteer/peer will check in with your child throughout the night)

Independent (Doesn't need any support)

Has your child attended Promapalooza in the past? *

Yes, I have been before!

No, this is my first time!

PHOTO/MEDIA RELEASE ACKNOWLEDGMENT *

I understand that while participating in this event, my child may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

Yes, I understand.

Consent & Liability Agreement *

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH PROMAPALOOZA 2022, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Project Inclusion and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that they are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS