FESTIVAL REGISTRATION FORM

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

NAME:______________________________

ADDRESS:______________________________

CITY:______________________________STATE:______________________________ZIP:______________________________

AGE:____________________PHONE:______________________________EMAIL:______________________________

List here any children 16 years or younger registering with this form. If the above named Adult is NOTthe child's legal guardian then a signed and noterized permission slip with phone number and address must be attached to this registration form.

NAME______________________________AGE:____________________

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 occuring to me or any minors under my care as a result of my participation or in connection with the festival. I understand that the Festivalis being held in a primitive camping area and that I need to excercise caution to maintainthe 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 under my care choose not to comply with all the 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 this waiver.)

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

PLEASE NOTE: This is NOT a clothing optional festival.
Signed this________day of 2__________

SIGNATURE:________________________________________________