Oxygen Signup Form Name* First Last Phone Number*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Birth* DD slash MM slash YYYY School Name* Year at School* Parent/Emergency Contact InformationParent/Guardian Name (1)* First Last Phone Number (1)*Email of Parent/Guardian (1)* Second Contact Person (2)* First Last Phone Number (2)*Email of Second Contact Person (2)* Medical InformationOther important information (e.g. medical info, allergies, special needs, etc)How will you be going home at the end of the night?* Going home with parent/guardian Going home with a friend’s parent/guardian (please inform leaders of who) Parent/guardian signature*