Feel The Vibe: Community Health Festival

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Research shows that 69,000 Youth in Arkansas under the age of 17 will die each year from tobacco related illnesses. In Honor of World No Tobacco Day, Brandon House is hosting Feel the Vibe: Community Health Festival to introduce healthy choices, support, and resources to Little Rock residents who desire to quit smoking, raise awareness, or celebrate and promote quitting on Friday, May 31, 2019 at 1pm - 5pm. If you would like to participate in any capacity, please complete this form below.

Email *

Friday. May 31, 2019 1pm - 5pm @ 4110 W. 12th Street, Little Rock, AR 72204

Contact Name *

Business/Organization Name

Business/Organization Address

Telephone Number *

Email Address *

How would you like to participate? *

I would like to bring students. (If chosen, please answer question #1)

I would like to be a vendor. (If chosen, please answer questions #2-#3)

I would like to register my team of 10-20 for water balloon Dodgeball. (If chosen, please answer question #4-#5)

STUDENT ATTENDANCE

If you desire to bring your program, please be ready to sign in each name at the registration table UNLESS you are able to provide an attendance roster for your students for May 31st at the check-in table. This roster must have student signatures or some indication that they were in attendance.

#1) How many students are you planning on attending this event?

VENDOR NOTE

Please be aware that all vendors must supply their own table and technology. This will be an outside event, so it is recommended that you provide your own tent if you so desire. Vendors are encouraged to arrive at 12:00 pm to set up.

#2) What kind of products/service are you vending?

#3) What are the prices of product/service?

WATER BALLOON DODGEBALL - NO LIABILITY CLAUSE

Please be aware that participating in Water Balloon Dodgeball releases any/all of the collaborative parties from any liability and waiver of the right to sue if any loss results from participation in the activity. Completing this form acknowledges an understanding of the nature of the activity and the risks involved, and chooses voluntarily to accept those risks. The participant agrees not to hold Brandon House Cultural & Performing Arts Center or any collaborative parties responsible for any loss or injury that may result from participation in the activity. Completing this form also indicates that the participant is financially responsible for any costs incurred as a result of treatment for injury while engaged in activity.

#4) In order to participate, you must check mark the following items:

I have read and understand that the No Liability Clause applies to ALL youth who participate under on behalf of the organization I represent.

I will agree to bring at least 100 FILLED water balloons (filled with plain tap water and no other substance) to contribute to the game

I understand that my team must follow the rules and directions of volunteer staff facilitating Dodgeball Game.

I have 10 - 20 team members who will participate in a game of Water Balloon Dodgeball. (Add Team Name Below)

Other:

A copy of your responses will be emailed to the address you provided.

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