Giovanni-Salvatore Gallitelli

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: GALLITELLI, GIOVANNI-SALVATORE

Age: 19
DOB: 04/20/1992
Gender: Male
Address: 200 Grand Street
City: New York
State: NY
Ethnicity: Italian Descent.
Height: 6'0
Weight: 155lbs
Eye Color: Dark Brown
Hair Color: Dark Brown
Distinguishing Marks: None.


Medical History:

Please list any and all allergies and age of onset below:
None.

Are you aware of any ongoing medical issues?:
None.

Please list any known ongoing medical issues of any dependents under the age of thirteen below. Please note to which dependent each issue belongs:
None.

If yes, list age of diagnoses by medical professionals, or age of onset below:
N/A

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:
N/A

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 smoke tobacco on occasion, and of course I don't drink. I'm under age.



Green Ridge Residential Registration:

Please list your chosen address within Green Ridge below:
2079 Black Creek Lane

Please list any dependents under the age of thirteen, who reside with you:
Carmilla Marie Gallitelli, daughter, age 12 months.

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

Please list any other residents at this address who are not dependents:
Benito DeLuca, Elio Gallitelli ((AKA: Emiliano Wysor, Head of Education)), Vincente Dinapoli ((AKA: Vincent Ward, Assitant to Tripp)), Carmilla Marie Gallitelli, daughter. ((And one or two others to follow...))

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

If married, please provide the name of your spouse if he/she resides with you:
Gwendolyn Gallitelli, patient at St. Christina's.

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:
None. ((Nothing taxable at least...))

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



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?:
No, I do not.

Please list your most recent employment and dates of employment below:
None.

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:
Not applicable.

How do you feel your previous employment will benefit your ability to perform in the position(s) for which you are applying?:
Greatly.



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 high school grade. Freshman/Sophomore/Junior/Senior:
N/A

Please provide the name of your previous high school below:
N/A

What are your academic strengths?:
N/A

What are your academic weaknesses?:
N/A

What was your previous Grade Point Average?:
N/A

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



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:
Yes. For a time I indulged in prescription opiates on occasion. I no longer care for medications.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:

Disturbing the Peace x2 - Ages 14 & 15
Operating a Vehicle Without a License - Age 15
Assault x3 - Ages 15 & 16
Possession of Narcotics - Age 16
Possession of Narcotics with Intent to Distribute - Age 17
Possession of an Unregistered Firearm - Age 17
Under-age Possession of a Firearm - Age 17
Assault with a Deadly Weapon - Age 17

At age 17 I was also charged with attempted murder, in connection with the latter three convictions. This charge was dropped on psychiatric grounds, and I was returned to The Hadley Institute for Troubled Youth for the second time, as sentence for the standing convictions. I held a midemeanour charge for drinking under age. This was expunged upon my eighteenth birthday. And as I said in the medical screening, I no longer drink under age.


If you answered yes to the above, please list sentences connected to these convictions below:
At age 16, I spent six months in a Juvenile Detention Center before I was remanded to The Hadley Institute for Troubled Youth towards the end of the year. My sentences were lessened on psychiatric grounds, and were served through psychiatric hospitalisation. I left Hadley after some months of rehabilitation. At age 17, I was again held in Juvenile Detention for a couple of months before returning to Hadley for a second time, at the direction of my court Psychiatrist, who lessened these convictions and sentences also. I left Hadley once again at age 17, almost 18, and I have been clean since.

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:
Of course not.



Personal Interview:

Why have you chosen to relocate to Green Ridge Island? Please explain below:
My wife was remanded to care at a facility on your island. My family and I have decided to relocate to be close to her during this very difficult time, and to aid in her recuperation and discharge from the facility.

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?:
I'm quite well versed, thank you.

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


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:

Giovanni-Salvatore Gallitelli 05/31/2011

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: 2079 Black Creek Lane
Residents at this Address: Giovanni-Salvatore Gallitelli, Benito DeLuca, Elio Gallitelli, Vincente Dinapoli, Carmilla Marie Gallitelli
Employment: N/A
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] Gallitelli, Giovanni-Salvatore
[b]Residential Address:[/b] 2079 Black Creek Lane
[b]Employment:[/b] N/A
[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.)