Riley Jantzen

Please use blue or black ink when filling out this registration form. Please answer all questions to the best of your ability. For further information or guidance, please contact a member of the Green Ridge town administration team at the number provided in our guide brochure.

Full Name: JANTZEN, RILEY ANNE

Age: 35 years old
DOB: 10/31/1975
Gender: Female
Address: 2723 Cruickshank Rd
City: Phoenicia
State: New York
Ethnicity: Italian American
Height: 5 ft 10 inches tall
Weight: 155-160 pounds
Eye Color: Brown
Hair Color: Brown
Distinguishing Marks: I have faint scars over my arms from some of the high spirited horses at one of my former jobs. I also have a 4 inch scar at the small of back from the surgeries I had received after it had been broken.


Medical History:

Please list any and all allergies and age of onset below:
No.

Are you aware of any ongoing medical issues?:
No.

Please list any known ongoing medical issues of any dependants under the age of thirteen below. Please note to which dependant each issue belongs:
No.

If yes, list age of diagnoses by medical professionals, or age of onset below:
No.

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:
I have a bottle of prescription strength ibuprofen that I only take as needed for my back. I haven’t had to get it filled in over a year.

Do you smoke tobacco, consume alcohol, or use street drugs? If yes, please list number of packs per day, number of drinks per day and/or names of consumed drugs below:
I drink on the rare occasion but nothing more then a couple of glasses. An addiction it is not.



Green Ridge Residential Registration:

Please list your chosen address within Green Ridge below:
12 Beach Rd. Apartment 118

Please list any dependants under the age of thirteen, who reside with you:
None

Please list any dependants over the age of thirteen who reside with you (Be advised that dependants over the age of thirteen must also complete a registration form):
None

Please list any other residents at this address who are not dependants:
None

Please list your marital status. Single/Married/Divorced/Widowed:
Single

If married, please provide the name of your spouse if he/she resides with you:
N/A

Please list any large taxable material possessions below, such as motor vehicles or other property of substantial value that will be relocating to Green Ridge Island with you:
A Red 2009 Saturn

Are you a citizen or a permanent (Green Card) resident of the United States of America?:
Citizen of the USA



Employment Registration (Optional):

This section is for those of age sixteen or older who plan to find employment on Green Ridge Island. If you do not meet the criteria, please move to the next section.

Do you plan to find employment on Green Ridge Island? If so, which position(s) are you applying for, and where?:
I’m applying as one of the Pine Hill Riding School Stable Hand

Please list your most recent employment and dates of employment below:
Hadley Institute – Feb. to May 2011
Wal Mart (Chinook, Montana) – 2009 to 2010
Hillside Riding Arena -- 1995 to 2005

Do you possess any other skills that you feel may benefit your ability to perform in the position(s) for which you are applying? Examples include extra languages, history of customer service and work in the care industries, etc. If yes, please list skills below:
I know my way around horses pretty well. I believe that I can use this to help your cause.

How do you feel your previous employment will benefit your ability to perform in the position(s) for which you are applying?:
I have learned what to do when things take a violent turn. Given some of the kids that were there, I take this as a valuable lesson.



Education Registration (Optional):

This section is for Green Ridge Island residents under the age of eighteen. All resident under the age of eighteen who do not possess a high school diploma, GED, or reside at St. Christina's Psychiatric Rehabilitation Center are required to complete this education registration. Those who do not meet these criteria, please disregard this section and move to the next.

Please list your highschool grade. Freshman/Sophomore/Junior/Senior:
Answer Here

Please provide the name of your previous highschool below:
Answer Here

What are your academic strengths?:
Answer Here

What are your academic weaknesses?:
Answer Here

What was your previous Grade Point Average?:
Answer Here

Are you interested in extracurricular activities such as sports, art clubs, maths clubs, etc? If yes, explain below:
Answer Here



Legal History:

Be advised that answers to this section will not affect your eligibility for relocation to Green Ridge. The information you provide will not be diverged to third parties.

Do/did you ever abuse controlled substances, including but not limited to prescription medications, street drugs or alcohol? If yes, please explain below:
No.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
No.

If you answered yes to the above, please list sentences connected to these convictions below:
No.

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:
I was almost charged with disturbing the peace and harassment at my old job in Wal Mart. But I had a very sexist co worker who did not know when to quit. So once I had explained the situation leading up to the monster argument, he ended up being the one charged instead.



Personal Interview:

Why have you chosen to relocate to Green Ridge Island? Please explain below:
My former place of employment is closing down and I want to continue working here.

Green Ridge Island houses a psychiatric rehabilitation hospital, and as such, living and working amongst those with mental health issues would be typical practice. Are you comfortable with this?:
Yes of course.

Do you agree to abide by all Green Ridge Island laws and regulations upon relocation?:
Absolutely.


Resident Signature:

By opting to relocate to Green Ridge Island and the town of Green Ridge, you hereby agree to abide by all Green Ridge Island laws and the instructions of Green Ridge Security, Green Ridge Town Officials, and St. Christina Facility administrators. You hereby waive rights granted to you by the state of Oregon or any other state belonging to the United States of America or to any other country or county. You acknowledge that Green Ridge Island, the town of Green Ridge and the St. Christina facilities are not subject to any state laws. You acknowledge that any personal property transported to Green Ridge Island becomes the responsibility of GR Biotech and its subsidiaries. You hereby waive your right to register to vote in any states within the continental United States, within the states of Alaska and Hawaii, and within any US territories. You waive your right to representation by any political parties or persons within the aforementioned US locations or other countries. You acknowledge that you are legally bound not to disclose information regarding Green Ridge laws, protocols or procedures of any kind with persons not residing on Green Ridge Island. You acknowledge that visitors to Green Ridge Island become the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as Green Ridge island residents during their stay. You acknowledge that visitors to Green Ridge Island are subject to surveillance by Green Ridge officials and employees, and may be removed from the island without notice. You acknowledge that any minors under the age of thirteen (13) that are claimed as dependants remain the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as all Green Ridge Island residents. GR Biotech and its Subsidiaries reserve the right to add to or amend these terms of service at any time.

Please sign and date below:

Riley Anne Jantzen 05/26/2011

Welcome to Green Ridge. Below you'll find your pertinent residential, employment and scholastic information. Please take this time to familiarise yourself with the island layout and requisite handbooks, rules and regulations. Thank you for joining our community.

Residential Address: 12 Beach Rd. Apartment 118
Residents at this Address: Riley Janzten
Employment: Stable Hand, Pine Hill Riding School
Education: N/A


Final Application Approval Steps for Players:


Before you can begin play on STC, you must complete these final steps:

• Sign up your playby on the faceclaim.
  
• Sign up for the who plays who list.
  
• Sign up for your assigned membergroup (shown above) HERE (Pay close attention to pick the correct usergroup listed on this approval stamp! Characters that are not signed up for their correct membergroups after approval will be subject to deletion during the next activity check.)
  
• Familiarise Yourself with your Staff & Resident Handbooks, located in the St. Christina's Rosters and Information, and Green Ridge Rosters & Information forums, on the main board.

Code:

[center][font=garamond][size=22][color=#555555][b] -File Note- [/b][/color][/size][/font]

_____________________________________________________________[/center]

[b]Resident Name:[/b] Jantzen, Riley
[b]Residential Address:[/b] 12 Beach Road/Apt. 118
[b]Employment:[/b] Stable Hand, Pine Hill Riding School
[b]Education:[/b] N/A

[center]_____________________________________________________________[/center]

[b]Note Subject:[/b] (Behavioural Report, Progress Report, Procedure Report, Disciplinary Report, etc.)

[b]Note Contents:[/b] (Explain behaviour observations, procedures, disciplinary actions, medical reports, etc. here)

[b]Note Author:[/b] (Your character name here.)

[b]Other:[/b] (Optional extra notes here.)