David Quick

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: Quick, David
Age: 22
DOB: 7/4/1989
Gender: Male
Address: 1722 Hillside Circle
City: Centerville
State: Utah
Ethnicity: Caucasian
Height: 5’8”
Weight: 145
Eye Color: brown
Hair Color: brown
Distinguishing Marks: none


Medical History:

Please list any and all allergies and age of onset below:

no

Are you aware of any ongoing medical issues?:

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:

no

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 occasionally, a few drinks on the weekends.

Please list any known ongoing medical issues of any dependents below. Please note to which dependent each issue belongs:

no



Green Ridge Residential Registration:

Please list your chosen address within Green Ridge below:

Apartment 209, 2 Holden Street

Please list any dependents who reside with you. Please include ages and relationship to yourself:

Viven – 10 mo. - niece

Please list your marital status. Single/Married/Divorced/Widowed. If married, please list name of spouse and note if he/she intends to reside with you at this address:

single

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:

2004 Honda Civic

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

yes



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?:

Heron Park Groundskeeper

Do you possess necessary qualifications for the position(s) for which you are applying? If yes, please list official qualifications below:

Yes, I have worked outdoors my whole life.

Please list your three most recent employment positions and locations of employment below:

gardener – Yellowbrook Nursery
clerk – Grab and Go Mini Mart
farmhand – Olde Time Apple Orchard


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:

Yes, I have years of experience farming and gardening.

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

It has given me experience to do my job well.



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:


Please provide the name of your previous high school below:


What are your academic strengths?:


What are your academic weaknesses?:


What was your previous Grade Point Average?:


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




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:

petty theft – 16 – I stole two shirts from a shopping mall.
petty theft – 17 – I stole an MP3 player from an electronics store.

If you answered yes to the above, please list sentences connected to these convictions below:

3 months probation
6 months probation, $200 fine

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

underage possession of alcohol



Personal Interview:

Why have you chosen to relocate to Green Ridge Island? Please explain below:

My sister Tara Anne Quick is living at St. Christina’s and I would like to be close to her so she can be with her daughter more often.

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

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

yes

Finally, please tell us a little about yourself. Where did you grow up, and what was it like? What were your prior relationships with significant others/family or friends like? What instances have lead to your current choice in career and/or relocation? What events in your life do you feel have shaped who you are today? Include any information you feel that is pertinent about yourself and your situations:

I grew up in Prosper, Utah. It was a FLDS community. I always felt a little of out place there, like I was just watching everything that was going on but wasn’t really a part of it. I was my father’s sixth child and my mother’s second, and neither of them paid me much attention. I mainly kept to myself the entire time I lived there, which was hard, because there were so many people in our house.

When I was thirteen or fourteen, I started questioning our community. My older full sister was 15 when she became the seventh wife of a 67 year old man. What really got me was how excited she was, she thought it was going to be perfect. I knew it was supposed to be a great opportunity for her, but I just couldn’t accept it. I began looking to the outside to see what it was like.

At 16, my father caught me with forbidden science books from the outside. They kicked me out of the community. I lived at the Hope shelter, and, for almost a year and a half, had no contact with anyone from my old life. Then my sister Tara Anne came to the Hope Shelter, pregnant from her husband. She got into some trouble and was sent to St. Christina’s, so I decided to move out here so she could be with her daughter, who is in my care.


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 dependents 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:

David Quick mm/dd/yyyy

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Chatango Screename: Lolasauce
Character Play-By Andrew Garfield