OUTMemphis, Nike MidSouth Pride, and Memphis Roller Derby Youth Skating Event!

OUTMemphis, Nike MidSouth Pride, and Memphis Roller Derby Youth Skating Event!
When:

Sun, Sept. 27th

Time:

11am-2pm

Where:

East End Skating Center (5718 Mt Moriah Rd, Memphis, TN 38115)

What:

OUTMemphis, Nike MidSouth Pride, and Memphis Roller Derby are partnering to host a community event for LGBTQIA+ youth ages 12-24!

Activities:

Memphis Roller Derby Discussion and Q&A

Memphis Roller Derby Team Demo

Free Skate

Food and Drinks Provided!
Name:

First NameLast Name
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Name (If under 18):

First NameLast Name
Parent/Guardian Email (If under 18):
example@example.com
Parent/Guardian Phone Number (If under 18):
Please enter a valid phone number.Format: (000) 000-0000.
Please List Allergies Below:
Do you need transportation to the event?
If you need transportation to the event, what is your pickup address?
Liability Waiver:
Please read and sign to convey understanding, and complete the bottom portion:

By signing below, I voluntarily agree to assume the full risk of any injuries, damages, or loss, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the roller skating Youth Day OUT event.

I do hereby fully release and forever discharge, hold harmless, and indemnify OUTMemphis, Memphis Roller Derby, and Nike Midsouth Pride and all participating staff, volunteers, agents, and assigns, or any and all of them (collectively the "Release Parties"), from any and all claims, cause of actions, suits, and liabilities of any kind of character whatsoever, known or unknown, suspect or unsuspected, in contract or in tort, at law or in equity, which I might have against the Released Parties, jointly or severely, for or by any reason of any matter which relates, in whole or in part, directly or indirectly, to the roller skating Youth Day OUT event.
Participant Signature
Parent/Guardian Signature (If Under 18)
Photo Release
I hereby authorize OUTMemphis to use, reproduce, and/or publish photographs and/or video that may pertain to me - including my image, likeness, and/or voice - without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs), or for other related endeavors. This material may also appear on OUTMemphis's internet web pages.

This authorization is continous, and may only be withdrawn by my specific recission of this authorization in writing to the Executive Director.

Consequently, OUTMemphis may publish materials, use my name, photograph, and/or make references to me in any manner that the corporation or project sponsor deems appropriate in order to promote or publicize service opportunities.
Participant Signature
Parent/Guardian Signature (If under 18)
Should be Empty:

OUTMemphis, Nike MidSouth Pride, and Memphis Roller Derby Youth Skating Event!

Liability Waiver:

Photo Release