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Glen Ridge Girls' Club Candy Cane 2021
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* Indicates required question
Escort Name:
*
Your answer
Name of Girls' Club Member:
*
Your answer
Emergency Contact/Parent Name:
*
Your answer
Parent/Guardian Telephone Number (must be available between 8 PM and 11 PM on 12/11/21):
*
Your answer
Parent/Guardian Signature:
*
We have been informed of and agree to abide by the Candy Cane Ball guidelines.
Your answer
Escort Signature:
*
I have read and agree to abide by the Candy Cane Ball guidelines.
Your answer
Parental Permission to use Photographs for Girls Club and Related Publicity:
*
Choose
Yes
No
Payment Option:
*
Venmo
Check
Not Applicable (Ticket Cost Covered by Girls' Club Member)
I will EMAIL Evidence of Vaccination to
girlsclubglenridge@gmail.com
or bring a Negative PCR Test (taken within 48 hours of the dance) to the event:
*
If you chose to email evidence of vaccination, please provide the name of the member that you will be accompanying in the email.
Choose
Email Evidence of Vaccination
Bring Negative PCR Test (within 48 hours)
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