| I hereby certify, under penalty of perjury, that I have never been convicted in New Jersey or any other
state or jurisdiction of any crime or disorderly person offense involving sex offenses, arson, armed robbery, aggravated assault, kidnapping, murder, manslaughter, or violations of the State or Federal Controlled Dangerous Substance Acts. |
| A conviction for any crime as listed above makes you ineligible for membership. Please check here to certify you have not been convicted. |
| Name: |
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| Address: |
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| City, State & Zip: |
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| Email: |
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| Telephone: |
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| Cell Phone: |
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| I verify that I am at least 18 years of age. |
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| Occupation: |
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| Are you available on weekends to attend investigations that conclude at
12:00AM? |
Yes No |
| Briefly describe your interest in paranormal research: |
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| Have you ever experienced a paranormal event? |
Yes No |
| If yes, briefly describe the event: |
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| Are you sensitive to paranormal events? |
Yes No |
| Do you have access to a computer? |
Yes No |
| Are you proficient on a computer? |
Yes No |
| List the types of research equipment,
if any, with which you are proficient, i.e. cameras, tape recorders, thermal equipment, camcorders, etc. |
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| Do you have any special skills or interests that you would like to contribute to the group? |
Yes No |
| If yes, please describe what they are: |
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| How did you hear about South Jersey Paranormal Research? |
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Medical Certification:
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| I understand that paranormal activity and research takes place under conditions that are required to be conducted in the dark and can be an emotionally charged activity.
I hereby certify that I am physically capable of participating in this sometimes-rigorous paranormal research activity and that I am aware of no physical/medical condition that would put
myself or others at risk under such conditions. I further certify that I will take all precautions necessary, including removing myself from such activity, should I find myself incapable of safely participating in any activity.
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Please check to confirm medical clearance.
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| Emergency Contact Information: |
Name
Telephone # |
| Your information is strictly confidential, and will be used for the sole purpose of verifying that the information gathered here is of a legitimate nature. Thank you. |
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