* required information
Registration Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
Names and ages of children attending:*
Names of additional guests:
Meal restrictions/special needs:
Emergency Contact Name:*
Emergency Contact Phone:*
I am interested in being an Arthritis Foundation Advocate: Yes
Liability Release Clause - Please Initial:
Photo Release Clause - Please Initial:
Liability and Photo Release Clauses - please initial above
Photo Release Clause
By initializing above: I hereby grant the Arthritis Foundation and its representatives, employees, and agents, the irrevocable and unrestricted right to use my words and story, reproduce and publish photographs, video and audio of me, including my image and likeness as depicted therein, for the world wide web, social networking sites, editorial, broadcast or any other purpose and in any manner and medium; to alter the same without restriction; to copyright the same; and waive any rights of compensation or ownership thereto. I hereby release the Arthritis Foundation and its trustees, officers, employees, agents, legal representatives and assigns from any and all claims, actions and liability relating to its use of said material.
Liability Release Clause
By initializing above: I understand and agree that my participation in the JA Family Day shall be at my and my child/children's own sole risk and that neither the Arthritis Foundation nor any co-sponsoring organization or facility, nor their respective chapters, officers, directors, employees, agents, members, or volunteers shall assume or have any responsibility or liability for expenses or medical treatment or for compensation for any injury I or my child/children may suffer during or resulting from our participation in this program. Further, in the event of emergency, I hereby authorize any and all medical attention to be administered that is deemed necessary by the attending physician or nurse.

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