LHF Teen Retreat, NOLA Loop Challenge Course, Saturday, March 2, 2024, 12-4PM (If under 18 a parent or legal guardian must fill out registration.)

City Park, 1031 Harrison Ave., New Orleans, LA 70124

1.Please provide us with the full name(s) of teen(s) ages 13-18 who will be attending. Must have a bleeding disorder or be the sibling of someone with a bleeding disorder.(Required.)
2.Phone Number(Required.)
3.Email address(Required.)
4.Illness/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 Teen Retreat, 3/2/2024.

Having such knowledge, I understand that I am solely responsible for my personal or my minor child(ren)'s safety and hereby release LHF, its representatives, agents, and event site host from liability for any illness or 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.(Required.)
5.THE Louisiana Hemophilia Foundation (LHF) PHOTO RELEASE Consent:

I hereby grant the LHF permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the LHF and will not be returned.

I hereby irrevocably authorize the LHF to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge the LHF from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED(Required.)
6.Parent or Legal Guardian Name. (Please insert N/A if you are 18)(Required.)
7.Questions or comments? We welcome all.
Current Progress,
0 of 7 answered