JHPeeps All-Nighter October 18th, 2017 Join us for the JHP All- Nighter, Friday November 17, from 8 PM to 8 AM! Bring a friend! Sign up and pay your $40 here! 2022 Liability Release Name of Participant* First Last Participant's Date of Birth* MM slash DD slash YYYY Participant's Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Participant's Gender*-MaleFemaleParticipant's Age* Participant's Grade*-6th7th8th9th10th11th12thParent/Guardian Name* First Last Insurance Company Contract Number Group Number Physician Physician's PhoneEmergency Contact Emergency Contact's PhoneParent 1 CellParent 2 CellAcknowledgement* I have read and agree to the information and requirements presented above. (Only participant needs to sign if 21 years of age or older. If under 21, both parents must sign unless parents are separated or divorced in which case custodial parent must sign.) Please initial below where indicated.Parent 1 (initials) Parent 2 (initials) Legal Guardian (initials) Participant, if age 21 (initials) Trip Participant Only I have read the forgoing and understand the rules of conduct for participants and will abide by them as well as the directions of the leadership of the trip.Participant (initials)*