Please list any medication you are taking.
Please list any food allergies.
Please include your insurance holder, policy number, and group number
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:
Release and Indemnification *
RELEASE AND INDEMNIFICATION: By registering your child(ren) or yourself for the Oklahoma Hemophilia Foundation Teen Retreat, 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.
Add extra attendees here in addition to special requests or comments.