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Camp Istrouma, 25975 Greenwells Spring Road

This event is offered at no charge to any Louisiana resident with a bleeding disorder and their immediate family members (caregivers/parents, spouses/partners, and siblings).  Friends and extended family are welcome to attend for a fee of $20 for adults (18 and up) and $10 for children (17 and under). Invoices will be sent for friends and extended family members prior to event. All invoices must be paid before event to attend.

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* 1. Full name of person with bleeding disorder

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* 2. Relationship to person with bleeding disorder

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* 3. Full name and age of extended family members and friends (An invoice will be sent to person registering extended family members or friends.)

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* 4. Phone number that you can be reached at during the day?

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* 5. Please provide email address to which you would like invoice sent to. Invoice must be paid prior to event to attend.

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* 6. Do any of the guests you are registering have a food allergy? If so, please list name(s) and food allergen below. If not please enter N/A.

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* 7. Assumption of the Risk and Waiver of Liability Relating to

Coronavirus/COVID/Accident:

The novel coronavirus, COVID, has been declared a worldwide pandemic by the World Health Organization. COVID is extremely contagious and is believed to spread mainly from person-to-person contact.

The Louisiana Hemophilia Foundation (“LHF”) has put in place preventative measures to reduce the spread of COVID along with following federal and state guidelines; however, the Louisiana Hemophilia Foundation cannot guarantee that you will not become infected with COVID. Further, attending the LHF Friends and Family Day, 4/30/2022, could increase your risk of contracting COVID.

By checking yes to this this agreement, I acknowledge the contagious nature of COVID and voluntarily assume the risk that I, and any family members and minor children I am registering, may be exposed to or infected by COVID by attending the LHF Friends and Family Day, 3/30/2022, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the LHF Friends and Family Day, 4/30/2022, may result from the actions, omissions, or negligence of myself and others, including, but not limited to, LHF employees, volunteers, and program participants and their families.

I, and on behalf of family members and minor children I am registering, voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or any family members and minor children I am registering, (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the LHF Friends and Family Day, 4/30/2022, or participation in LHF programming (“Claims”). On behalf of myself and family members and minor children I am registering, hereby release, covenant not to sue, discharge, and hold harmless the Louisiana Hemophilia Foundation, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Louisiana Hemophilia Foundation, its employees, agents, and representatives, whether a COVID infection or injury occurs before, during, or after participation in any LHF program.

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* 8. Questions or comment? We welcome all!

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