REGISTRATION FORM

CIRCLE OF THE BLUE MOON
202 PIN OAK PLACE
FRANKFORT, KY 40601

NAME____________________________________________________________
ADDRESS_________________________________________________________
CITY_____________________STATE_____________ZIP___________________
AGE_____________________PHONE______________E MAIL_______________

List here any children 16 or younger registering with this form. If the above named Adult is NOT the child?s legal guardian then a permission slip with phone number and address must be signed by the minor?s legal guardian and mailed with the registration Form.

List here any medical conditions we may need to know about __________________ _______________________________________________________________

WAIVER:
I understand that I assume all responsibility for my personal welfare, personal property and any minors or pets under my care at all times and under all circumstances. I will not hold the landowners or Festival Staff liable for any personal injury or loss occurring to me or any minors under my care as a result of my participation or in connection with the Festival. I understand that the Festival is being held in a primitive camping area and that I need to Exercise caution to maintain the health and safety of myself and any minors or pets under my care. I understand that any medical, childcare, or other services at the festival I choose to use for myself or any minors under my care are totally at my own risk. I understand fully that if I or the minors in my care choose not to comply with all Festival guidelines I/we will be required to leave without refund and I/we agree to comply. (My signature indicates that I am in full agreement with the terms of the waiver.)

POSSESSION OF ANY ILLEGAL DRUGS AND FIREARMS IS PROHIBITED ON THE FESTIVAL SITE.

PLEASE NOTE: This is NOT a clothing optional festival.


Date ________________ 2_____. Signature_______________________________