Faultline Frolic 2022 A La Carte Registration

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A separate form is required for each registrant.

Questions or problems? Please contact the Registrar, Rhonda Cayford, at ffregistrar@nbcds.org, or by phone at 925-788-2832

Email *

Registrant Information

First Name *

Last Name *

Address

City *

State *

Zip

Phone *

Preferred Name Tag

(If left blank, we'll use First Name):

Roster: Please do NOT list my

(Check all that apply)

Name

Street Address

City, State, Zip

Phone

COVID Policy - ALL participants must be fully vaccinated. This means either an initial set of approved vaccines and a booster at least two weeks prior to the dance, or initial set of vaccines no more than 6 months prior to the dance. Participants under the age of 12 do not need to have a booster. Please mark all that apply. *

I have received either one J&J vaccine or two Pfizer or Moderna vaccines

I have received at least one booster vaccine

I am not eligible for a booster

I will bring proof of vaccination to the event.

Required

Participants must agree to follow COVID safety policies for this event. Please indicate your agreement to the following: *

I will wear a well-fitting mask at all times that I am in the dance space

If I have any signs of illness (fever, headache, etc) I will not attend the event

If I become ill or test positive for COVID within 5 days of the event, I will notify event organizers.

Required

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