Alt Factor Challenge Sign-ups
Enter your details to be considered. Show is Sept. 12th @ 37th&Zen @ 9PM! If chosen, you will be automatically entered into our raffle!
Name
*
Pronouns
IG:
Email Address
*
example@example.com
Why do you want to be a part of Alt Factor?
Are you able to commit to Sept. 12th at 9pm?
*
Yes
No
Liability Waiver
Please read through thoroughly!
Please select yes, if you agree to the risks of eating dehydrated food grade bugs. Please select no, if you do not wish to proceed.
*
Please Select
Yes
No
Please select yes, if you agree to the risks of blindly reaching for unknown objects. Please select no, if you do not wish to proceed.
*
Please Select
Yes
No
Please select yes, if you agree to the risks of being enclosed in small spaces. Please select no, if you do not wish to proceed.
*
Please Select
Yes
No
Please select yes, if you acknowledge 37th&Zen, Mad Maxii, Maso Kissed Belladonna, & Bearcub Belladonna are not liable for any injuries or harm that may fall upon you during Alt Factor and while at 37th&Zen. Select no, if you do not wish to take upon the risks involved with participating in a show similar to fear factor.
*
Please Select
Yes
No
Are you sensitive to strobing effects?
*
Yes
No
What textures are you sensitive to? (If none, put N/A)
*
What are you allergic to (If none, put N/A)?
*
Emergency Contact Name
*
First Name
Last Name
Signature
*
Additional Comments
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Should be Empty: