Anime Boston 2007 Cosplay Human Chess Participation Form for Minors

(Please print from your computer and submit it to Masquerade HQ when you check in.)

Participant's Name: _____________________________________________

Date of Birth: __________________________ Age: ________________

Phone Number: ___________________________________________________

Address:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

I, ____________________________________,

grant permission for ___________________________ to participate in the Cosplay Human Chess event taking place on April 22, 2007. I am aware that Cosplay Human Chess may last into the afternoon and I am prepared to let the participant stay for the full event. I further give my consent to Anime Boston to acquire emergency medical treatment from competent medical personnel/facilities should that become necessary for any reason. I also understand that the event will be recorded and photographed and that photos or recordings of the event may be used by Anime Boston or The New England Anime Society for promotional purposes.

Guardian's Name (Print): _______________________________________

Guardian's Signature: _________________________ Date: __________

Guardian's Relation to Applicant: ______________________________

• Cosplay Human Chess Information
• Cosplay Human Chess Rules & FAQ
• Cosplay Human Chess Application Form
• Cosplay Human Chess Participation Form for Minors