Register

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.  

Name of Youth *
Name of Youth
Each youth must be registered individually.
Address *
Address
Write the youth's address.
Phone *
Phone
PARENT or GUARDIAN'S NAME 1 *
PARENT or GUARDIAN'S NAME 1
Write the name of a legal parent or guardian.
Phone 1 *
Phone 1
PARENT or GUARDIAN'S NAME 2
PARENT or GUARDIAN'S NAME 2
Phone 2
Phone 2
The parent/legal guardian hereby indicates his or her consent to the above named child's participation in the Oklahoma Hemophilia Foundation Annual Meeting Children's and Teen’s Programs and baby-sitting on 07/29/17 by signing or typing his or her in initials in the box below. The undersigned does hereby release, hold harmless and agree to indemnify the Oklahoma Hemophilia Foundation, its Board of Directors and representatives from any and all liability resulting in the participation of the above named child in the event and/or activities sponsored and conducted by the Oklahoma Hemophilia Foundation. I accept the terms of this of this Release & Consent:
Name of Legal Parent or Guardian *
Name of Legal Parent or Guardian
Date *
Date