Community Connections Registration Form Enjoy a full day of activities with MEarth, family, and friends this year! Community Connections days are on November 21, 2021, December 19, 2021, and March 27, 2022. Step 1 of 5 20% Which Community Connection are you registering for?*Fall (November 21, 2022)Winter (December 19, 2022)Spring (March 27, 2022)Do you have a discount code from a MEarth partner (BGC, BlueZones, etc.)? Please enter here: How many discounted adults (18+) are you registering? Price: $10.00 Quantity: How many discounted children are you registering? Price: $5.00 Quantity: How many adults (18+) are you registering? Price: $15.00 Quantity: How many children are you registering? Price: $10.00 Quantity: How many infants or toddlers (under 3) are you registering? Price: $0.00 Quantity: Please list the name(s) of the participants you are registering for the MEarth Community Day:*Note that additional paperwork will be required for registered participants. How did you hear about MEarth Community Days? Registrant InformationThe following fields ask for information about the registrant, parent, or guardian who is registering the participants for MEarth Community Days. Once registration is completed, additional paperwork will be required for each participant.Registrant First Name* First Registrant Last Name* Last Registrant Email* Registrant Phone*Registrant Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I understand and acknowledge that activities at MEarth Camp, such as hiking and working with tools, pose risks to my child, including risks of cuts, strains, sprains, sunburn, insect bites and serious injury or death. As a parent or guardian of the above named minor, do hereby, for my child, myself, my heirs, executors and administrators, release and forever discharge MEarth and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the minor’s participation in the MEarth Community Connections Events.eSignature for Participant Liability Waiver Do you understand that all participants in this MEarth program will require full compliance with Covid-19 related safety measures, protocols, and communications, and that lack of compliance may result in the termination of their participation without refund of registration fees?* Yes No Total $0.00 CAPTCHA
