RM_StatsRegistration for the Halloween Dance 2023Each participant must register separately. If you are registering your family, please fill out a registration form for each participant in your family. Accompanying adult(s)/ chaperone(s) do not have to pay a dance fee.Please join us for our Halloween Dance on Saturday October 28th, 6:30-8:30 PM in the St.Monica's Auditorium. We will have signage outside and parking is available in the St. Monica's parking lot. A spooky DJ and light refreshments will be provided! Please wear your favorite costume. Note : There is no elevator in the auditorium , therefore this event is not fully wheelchair accessible.Participant's First Name *Participant's Last Name *Participant's Age *Parent / Guardian Email *Parent / Guardian Cell Phone * Are you registering for a participant in a group home? * Yes No If Yes, Please List the Name of the Group Home I understand a responsible adult (18+) must accompany the participant for the duration of the dance * Yes, I understand Name of Adult Accompanying Participant * Assumption of the Risk and Waiver of Liability *I have read and agreeBy checking this box, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to or infected by COVID-19 by attending the Foundation's events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Foundation's events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Foundation volunteers and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Foundation's events or participation in Foundation programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the 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 there to. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Foundation, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Foundation program. To pay the $10 dance fee click the submit button, you will be redirected to PayPal to submit payment for the dance fee and finish registration. * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
