LHF Young Adult Retreat, Camp Istrouma Greenwell Springs , August 8th-10th (Must be 18 - 27 years old to attend)
25975 Greenwell Springs Rd, Greenwell Springs, LA 70739
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1.
Please provide us with your Full Name, age must be 18 - 27 years old. Must have a bleeding disorder or be the sibling/spouse of someone with a bleeding disorder.
(Required.)
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2.
Phone Number
(Required.)
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3.
Email address
(Required.)
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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 Young Adults Retreat, August 9th-10th.
Having such knowledge, I 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.
(Required.)
Yes
No
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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.)
Yes
No
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6.
I acknowledge that leaving the event facility will result in forfeiting my ability to return, as re-entry is not permitted under any circumstances
(Required.)
Yes
No
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7.
Emergency Contact Name & Number
(Required.)
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8.
Please list any Food Allergies or N/A
(Required.)
9.
Questions or comments? We welcome all.
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