Utah JA Family Day

Saturday, October 5, 2013 from 10:00 am - 1:00 pm

Check-in begins at 9:30 am at the Theater


Discovery Gateway Children's Museum
444 West 100 South
Salt Lake City, UT 84101

JA Family Day is an event for children and teens with rheumatic conditions, and their families! Join us to learn about arthritis, network with families who have similar concerns, and enjoy a day of fun activities!

Registration is required by September 20, 2013.

In order for us to prepare for the dayís activities, please register all adults and children that will be attending. All family members are welcome. Include names, ages of children, and, if applicable, the specific type of Juvenile Arthritis. If you have questions about the registration process please contact Andrea Aho at 888.391.9389, opt 7

* required information
Registration 
Registration Information
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Email:*
Name 1 (First & Last):
Name 1 Age:
1-Type of Arthritis:
Name 2 (First & Last):
Name 2 Age:
2-Type of Arthritis:
Name 3 (First & Last):
Name 3 Age:
3-Type of Arthritis:
Name 4 (First & Last):
Name 4 Age:
4-Type of Arthritis:
Name 5 (First & Last):
Name 5 Age:
5-Type of Arthritis:
Name 6 (First & Last):
Name 6 Age:
6-Type of Arthritis:
Name 7 (First & Last):
Name 7 Age:
7-Type of Arthritis:
Fees
$15.00 Family Registration
General Registration

Additional Donation

Your donation will help the Arthritis Foundation serve the estimated 300,000 children who live with arthritis in the United States. Please consider making an additional donation here.
Amount:$

A limited number of scholarships are available. If you need one please contact Andrea Aho at 888.391.9389, opt 7, ext 101.


WAIVER: 1. In consideration of this application to participate in the Arthritis Foundationís JA Program being accepted, I hereby waive and forever discharge the sponsors, organizers, affiliates as well as their agents and employees from any and all claims that may occur as a result of my familyís participation. 2. I hereby grant the Arthritis Foundation specific permission to reproduce, publish, circulate, copyright, or otherwise use any and all photographs and/or videotape of me and/or my family taken at this JA Program for use by the Arthritis Foundation. 3. I understand that the Arthritis Foundation and the facility retain the right to enforce the rules of the JA Program and the facility and if necessary send home anyone infringing on the rights or safety of others.4. I understand that the Arthritis Foundation, JA Program, and the facility DO NOT carry accident insurance for the child or adult participants. I will be held responsible for providing my own insurance/medical coverage, if need be, for myself and all members of my family.



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