Coordinated by: Reality Tour® Registration Form 2016 SUMMER 2019
Reality Tour ® begins at 5:45pm at the Indiana County Jail, 665 Hood School Road, Indiana, PA 15701 Registration Requirements (READ THE BACK OF THIS FORM FOR IMPORTANT REQUIREMENTS). Must be 10 years old and up. Youth must attend with a parent or adult. Families are strongly encouraged to attend together. Step one. Register for your tour by reading and completing this form in its entirety. Must pre-register for groups. Call Armstrong Indiana Clarion Drug and Alcohol Commission at 724.354.2746 x 309. Access and download this form: http://www.aidac.org/ Scroll to the bottom of home page for tour information. On-line registration is available. Go to http://www.aidac.org/ Scroll to the bottom of home page and access the link to the Eventbrite site. Complete the entire form on-line and click “REGISTER” to submit the form. Step two. Choose one date for your tour: SUMMER 2019 DATES August 7, 2019 September 4, 2019 Step three. Read and sign the Reality Tour Consent. The undersigned understands that the following scenarios are included in the Reality Tour®. Some portions of the Reality Tour® are emotionally intense and parental guidance is a must. Check below boxes ONLY if you DO NOT wish to see the following tour scenes:
Peer Pressure Scene Emergency Room / Overdose Funeral Scene Arrest / Imprisonment
I permit my child / children listed below to participate in the Reality Tour® and the self-reported survey data collection included in the program. I understand The Reality Tour® is appropriate for children 10-18 and a PARENT or LEGAL GUARDIAN must be present. I have the front and back of this form and agree not to hold CANDLE, Inc. the Armstrong Indiana Clarion Drug and Alcohol Commission or its affiliates liable for any claims, damages, demands, actions, or lawsuits that could arise as a result of my participation or my minor child’s participation in the Reality Tour®. I am aware news cameras and/or reporters may be present at Reality Tour ®. I realize that volunteers are dedicating their time to the Reality Tour and I plan to honor my registration by attending the Reality Tour on the confirmed date.
______/____/____ (Signature of Parent or Guardian) (Print Name Here) (Date) Step four. Consenting Adult Contact Information for Confirmation– Please Print Neatly E-mail Address: Phone (Home): (Other): Address:
Step five. Tour Guests – Please print neatly all of information for those attending the Reality Tour®. Print First and Last Names Ages Mandated to Attend (YES OR NO) Names of Schools/ Districts 1. 2. 3. 4. 5. Step six. Submit your completed registration form. Completed registration forms must be received 1 week before requested tour date. Registration is not completed until signed waiver form is received and you are contacted with a confirmation. Must pre-register for groups. Call Armstrong Indiana Clarion Drug and Alcohol Commission at 724.354.2746 x 309. Fax completed forms to: 724.354.3132 Mail completed forms to: Armstrong Indiana Clarion Drug and Alcohol Commission c/o Indiana County Reality Tour P.O. Box 238, 10829 U.S. Route 422 Shelocta, PA 15774
What is a Reality Tour?
Coordinated by: Reality Tour® Registration Form 2016 SUMMER 2019
The Reality Tour© is a drug awareness and prevention program that takes you into the life experiences of a teen addicted to heroin. It’s an experience that will create a lasting impact on all who attend.
A great way for adults to start the conversation with youth about alcohol, tobacco, and other drug use!
The Reality Tour© includes: Dramatic scenes that depict an arrest and imprisonment, an emergency room overdose, and a funeral. Informative and interactive discussions about types of drugs and addiction. Local information regarding drug and alcohol trends in Indiana County, PA. Youth learn about various peer pressure refusal skills. Questions and answers with people in recovery and law enforcement officials. Youth will have a “mug shot” taken that will be morphed to show how drugs affect physical appearance.
REALITY TOUR® is the property of CANDLE, Inc., a 501 (c) (3) non-profit organization (www.candleinc.org). How do I register for the Reality Tour? REGISTRATION FORM ON BACK OF THIS SHEET Read the front and back of this form. Complete the front of this form and submit the form (read below). Access and download this form: http://www.aidac.org/ Scroll to the bottom of home page for tour information. On-line registration is available. Go to http://www.aidac.org/ Scroll to the bottom of home page and access the link to the Eventbrite site. Complete the entire form on-line and click “REGISTER” to submit the form. Must pre-register for groups. Call AIC Drug and Alcohol Commission at 724.354.2746 x 309. Fax completed forms to: 724.354.3132 Mail completed forms to: Armstrong Indiana Clarion Drug and Alcohol Commission c/o Indiana County Reality Tour P.O. Box 238, 10829 U.S. Route 422 Shelocta, PA 15774 When is the Reality Tour? Check the front of this form for available school year dates. Arrive by 5:45pm at the Indiana County Jail (665 Hood School Road, Indiana, PA 15701). Can I take my phone into the jail? No phones or electronic devices are permitted. No personal belongings allowed on the tour- leave all items except keys and coats locked in your vehicle. No hats, hoodies, clothing with hoods, baggy clothes, or chains permitted. Lockers will be available for your coats and keys (a quarter is provided). You will have to sign in and walk through a metal detector before the tour begins. How do I know if I am registered for the Reality Tour? Registration is not completed until signed waiver form is received and you are contacted with a confirmation. Please check that your submitted contact information was correct. If you have not received a confirmation before one week of the requested tour date, please call the Armstrong Indiana Clarion Drug and Alcohol Commission at 724.354.2746 x 309. What if I have to cancel? As soon as you realize the requested date for the Reality Tour will not work for you, please call the Armstrong Indiana Clarion Drug and Alcohol Commission at 724.354.2746 x 309 so we can provide your registration to another family and also reschedule your Reality Tour date. If you decide to not attend the registered Reality Tour date you may not be rescheduled.