LHF 2021 Annual Meeting Registration

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* 1. Full name and Bleeding Disorder (if applicable) of adults in your family that you will be registering. At least one family member must have a bleeding disorder to attend. LHF will provide one hotel room per family.

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* 2. Full name, age, and bleeding disorder, if applicable, of all children ages 3-13 that will attending our childcare services. Child must be potty trained.

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* 3. Full name, age, bleeding disorder, if applicable, of all teens age 13-18 that will be attending our teen activities and sessions.

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* 4. Indirect family members or friends of those affected by a bleeding disorder may attend at a cost of $225 for up to two adults for the full weekend. (invoice will be sent to registered email address)

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

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* 6. Please provide email address.

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* 7. Please provide your home address. Mileage reimbursement will be provided to those who reside 50+ miles away from event location of 4914 Constitution Ave., Baton Rouge, LA 70808.

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* 8. Hotel accommodations will be provided by LHF for registered patient guest only and their spouse/caretaker/support person and child(ren). One room per family. Please check room type.

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* 9. Will you be staying both Friday and Saturday night in hotel accommodations?

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

Coronavirus/COVID-19

     The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and wearing of face coverings and have, in many locations, prohibited the congregation of groups of people.

     The Louisiana Hemophilia Foundation (“LHF”) has put in place preventative measures to reduce the spread of COVID-19; however, the Louisiana Hemophilia Foundation cannot guarantee that you will not become infected with COVID-19. Further, attending the LHF Annual Meeting, 10/8-9/2021, could increase your risk of contracting COVID-19.

     By checking yes to this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the LHF Annual Meeting, 10/8-9/2021, 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 Annual Meeting, 10/8-9/2021, may result from the actions, omissions, or negligence of my child(ren) or myself and others, including, but not limited to, LHF employees, volunteers, and program participants and their families.

      I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (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 Annual Meeting, 10/8-9/2021, or participation in LHF programming (“Claims”). On behalf of my child(ren) and myself, I 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-19 infection occurs before, during, or after participation in any LHF program.


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* 11. Accident/Injury Liability Waiver

I, the undersigned, being aware of my own health, limitations, and physical condition, acknowledge that I am voluntarily participating in the LHF Annual Meeting, 10/8-9/2021.

Having such knowledge, I understand that I am solely responsible for my personal safety and hereby release LHF, its representatives, agents, and event site host from liability for any accidental injury that may result from participation in this program.

I also accept this liability on behalf of my child(ren), and furthermore agree to supervise adequately to prevent injury.

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* 12. Questions or comment? We welcome all!

0 of 12 answered
 

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