Register: Annual Meeting Youth Activities — Oklahoma Hemophilia Foundation

OHF ANNUAL MEETING 2019

YOUTH Registration is now open!

The following registration is for Youth Activities. Each youth must be registered individually. Youth Activities are limited to those who have bleeding disorders and their immediate family members. These activities are off-site and for youth ages 7-12 years old and 13-17 years old. On-site activities are available for ages 3-6 years old, and babysitting is available for children 0-2 years old.

Age Group of Youth

Name of Youth

Each youth must be registered individually.

First Name

Last Name

Age of Youth

He/She is...

Choose one or more description.

Affected

A (symptomatic) carrier

A sibling

A family member

Other

Address

Write the youth's address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

PARENT or GUARDIAN'S NAME 1

Write the name of a legal parent or guardian.

First Name

Last Name

Phone 1

(###)

###

####

PARENT or GUARDIAN'S NAME 2

First Name

Last Name

Phone 2

(###)

###

####

Email Address

Please list ALL MEDICAL CONDITIONS/ALLEGIES AND ALL MEDICATIONS (including those for bleeding disorder) that chaperons need to be aware of during the event. Keep in mind that it may be necessary to pre-treat your child before they leave for the event.

RELEASE AND INDEMNIFICATION

By registering your child(ren) or yourself for the Oklahoma Hemophilia Foundation Annual Meeting Children's and Teen’s Programs and baby-sitting on July 27, 2019 in Oklahoma City, Oklahoma, you hereby assume all of the risks for your child(ren) or yourself of participating in such events and/or activities. Further, you hereby release, indemnify, defend, discharge and hold the Oklahoma Hemophilia Foundation and its Board of Directors, employees, agents and representatives harmless from and against all liabilities, claims, damages, injuries, losses, causes of actions and costs and expenses (including, without limitation, reasonable attorneys’ fees) directly or indirectly arising out of or attributable to your child’s (children’s) or your participation in the above-described events and/or activities. By registering for your child(ren), you hereby acknowledge that you are the parent or legal guardian of the minor child(ren) named in this registration and have the legal authority to execute this release and indemnification on behalf of the child(ren) named in this registration.

Name of Legal Parent or Guardian

First Name

Last Name

Date

YYYY

Photo Release

I grant to the Oklahoma Hemophilia Foundation (OHF), its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize OHF, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that OHF may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above:

Requests or Comments