Positive Force Initiative Registration Form

Name

First Name

Last Name

Age

Race/Ethnicity

Gender

Education Level

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Have you served, or are currently serving in the US Military (i.e. Active Duty, Guard, Reserve, or Veteran)?

Do you have any children (under 18) in your home regularly?

Dietary Restrictions

Example: Nut Allergy, Gluten, Shellfish, Dairy, etc. (If no restrictions, please input NONE)

I acknowledge that in attending WhitneyStrong’s Save A Life event I may be in proximity with people who may be carriers of the COVID-19 virus, and I agree that WhitneyStrong shall have no legal responsibility for any illness I may have in the future.

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