Version 2023.3.02 First Name* Middle Name* Last Name* Address* City* State* Zip Code* Home Phone* Home Phone - 10 DIGIT - NO DASH Cell Phone* Cell Phone - 10 DIGIT - NO DASH Email* Gender* Male Female Are you Male or Female? Birth Date* MM/DD/YYYYY Age* Age - 2 DIGIT (EX 16 or 56) Over 18* Over 18 Under 18 CPR Training* Yes No Do you have CPR training? Emergency Name 1* Additional Persons to Contact in Emergency (PLEASE LIST 2), NOT AT THE SAME PHONE NUMBER Emergency Phone 1* 10 Digits - NO DASH Emergency Name 2* Additional Persons to Contact in Emergency (PLEASE LIST 2), NOT AT THE SAME PHONE NUMBER Emergency Phone 2* 10 Digits - NO DASH Medical Conditions* Please list any known medical conditions or allergies. If None specify "none" HCSI Member* Yes No Organization* HCSI BAND PARENTS ORCH PARENTS CHORUS PARENTS ST KILLIANS WORK CAMP HUHS ROBOTICS WHITEWATER DECA HARTFORD PLAYERS BOYSCOUTS LITTLE SWITZERLAND SKI PATROL PLEASE APPLY MY HOURS TO THE FOLLOWING ORGANIZATION. HOURS WILL BE APPLIED TO ORGANIZATIONS MARKED. IF NO ORGANIZATION IS MARKED HOURS WILL APPLY TO H.C.S.I. ONLY H.C.S.I. MEMBERS MAY SPLIT HOURS. H.C.S.I. MEMBERS MUST APPLY 50% OF HOURS WORKED TO H.C.S.I. AND ARE STRONGLY ENCOURAGED TO APPLY HOURS TO H.C.S.I. ONLY. (*) EXCEPT FOR H.C.S.I. YOU MUST BE 18 AND A CURRENT MEMBER OF THE ORGANIZATION MARKED FOR YOUR HOURS TO COUNT. License Plate* Please enter your LICENSE PLATE if driving a Vehicle to the event. Smoke* Yes No Will you work in smoke/fog? Strobe Lights* Yes No Will you work in flashing lights or strobes? Claustrophobic* Yes No Are you claustrophobic? Loud Noises* Yes No Will you work in areas with loud music/noises? Makeup* Yes No Will you wear makeup? Pitch Black* Yes No Will you work in pitch black with no light? Shirt Size* KS KM KL S M L XL 2XL 3XL 4XL What size T-Shirt do you wear? Height* 4'0 4'1 4'2 4'3 4'4 4'5 4'6 4'7 4'8 4'9 4'10 4'11 5'0 5'1 5'2 5'3 5'4 5'5 5'6 5'7 5'8 5'9 5'10 5'11 6'0 6'1 6'2 6'3 6'4 6'5 6'6 6'7 6'8 How tall are you? September 30th* Yes No Please specify if you are available to work this night. October 6th* Yes No Please specify if you are available to work this night. October 7th* Yes No Please specify if you are available to work this night. October 13th* Yes No Please specify if you are available to work this night. October 14th* Yes No Please specify if you are available to work this night. October 20th* Yes No Please specify if you are available to work this night. October 21st* Yes No Please specify if you are available to work this night. October 27th* Yes No Please specify if you are available to work this night. October 28th* Yes No Please specify if you are available to work this night.
