Community Day Health Fair Registration

Name

Date of Birth

Email Address

Home Address

Message

List the age(s) of any child(ren) 18 or younger you are bringing.

Are You 18 or over? Are You 18 or over? Yes No

Will any children 18 or younger accompany you to the Health Fair? Will any children 18 or younger accompany you to the Health Fair? Yes No

Media Release Consent – REQUIRED • Do you agree to be featured in photos, videos, and/or on social media related to this event? Media Release Consent – REQUIRED • Do you agree to be featured in photos, videos, and/or on social media related to this event? Yes No

Event Participation Consent Event Participation Consent Yes No