The Great Cloth Diaper Change - Pre-Registration Form

Pre-Registration Form (Please fill out one form for each baby/toddler)
COME AND HELP SET A GUINNESSTM WORLD RECORD!

Cloth diapers have come a long way in past 10 years, and it’s time to stand up and be noticed. Join the cloth diaper community on April 23rd, 2011, at 9AM PDT / 10 AM PDT / 11CDT / 12 EDT to set a world record for the most cloth diapers changed simultaneously. There will be families on several continents joining us!

INFORMATION ABOUT YOUR LOCAL EVENT
Event Date: Saturday, April 23, 2011 Event Start Time: 10:30 AM
Event Location: St. Philips Catholic Church Community Center 113 2nd Avenue South Franklin, TN 37064

Telephone: (615) 542-4338 E-Mail: greenpixiebaby@hotmail.com

Event Description: The first 36 participants will receive a free goodie bag, snacks, and beverages will be served.

Due to space constraints, pre-registration is advised. Please RSVP on our Facebook page. http://www.facebook.com/greenpixiebaby

If space is available on day of event, onsite registration will be accepted but cannot be guaranteed.

EVENT RULES
There are a few rules to keep in mind:
1. Arrive on time!
2. For this record, each baby must be changed from a cloth or disposable diaper into a reusable cloth diaper that must be able to be purchased online or in a retail store. Unfortunately, homemade diapers that are not commercially available cannot be used. This is a very strict rule from Guinness World RecordsTM.
3. All babies and toddlers must be 39 inches or shorter.
4. Each baby must be paired with exactly one adult participant.

DONATION
Please bring $1 (or more) as a donation to the Real Diaper Association, the 501(c)(3) nonprofit organization dedicated to spreading the word about reusable cloth diapers.
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Information about Adult: Name________________________________________________________________________

Street Address __________________________________________________________________________
City __________________________________________ State _________ Zip _____________________
Telephone _____________________ Email __________________________________________________

About Baby: Name ___________________________ Date of Birth: _____________ Height of Baby (inches): _________
Brand and Style of Cloth Diaper Being Used: ___________________________________________________
Don’t have a cloth diaper but want to participate? No problem! Check here: □
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Please cut out the bottom part of this form and mail, fax, or bring to:
The Shop Around the Corner 117 Third Avenue N. Franklin, TN 37064

OR bring with you on the day of the event