Screen Reader Mode Icon

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.

Question Title

* 1. Full name of person with bleeding disorder

Question Title

* 2. Relationship to person with bleeding disorder

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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.

Question Title

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

Illness/Accident/Injury/Photo Release:

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, 4/20/2024, 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 illness or injury occurs before, during, or after participation in any LHF program.

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

Question Title

* 8. Questions or comment? We welcome all!

0 of 8 answered
 

T