AMPED Pandemic Game Registration Form

Pandemic Game Registration Form

Each person planning to play the game will need to fill out one of these. Looking forward to seeing you soon!
Attendee Information

Please fill out the information below:
Attendee's Name

First Name Last Name
Birth Date

Month Day Year
Gender

MaleFemaleOther
Current School:
Grade:
Email:
example@example.com
Phone Number
Please enter a valid phone number.
Have you ever played the Pandemic Game?

YESNO
Are you planning to be a participant? Or Game Master? (Game Masters have played the game before and will assist with facilitating the game)

Play as ParticipantPlay as Game Master
T-Shirt Size:

SMLXL2XL3XL
Please list any dietary restrictions:
Parent/Guardian Information (if under 18)
Name

First Name Last Name
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Photo Consent and Acknowledgement

During the event, we will have photographers and videographers documenting the event in its entirety. Please acknowledge you understand the we may use digital media taken from this event that may include you for presentation purposes.
Photo Consent Acknowledgement*

I acknowledge and confirm
Should be Empty:

Pandemic Game Registration Form