Family Engagement R.S.V.P Form
Thank you for joining us for some Family Fun!! Our mission is to Educate,Empower, and Equip at-risk families with the skills to overcome adversities caused by incarceration, divorce, or military deployment. Our goal is to reduce the pain and stigma experienced by families, and improve communication between the child and the returned parent after the family has been impacted by adversity. We have several workshops/events planned to help you create moments for a life time with your child. Please take full advantage of the opportunities provided free of charge for you and your family!
Full Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
E-mail
Have you been Incarcerated before?
How many of your kids will be joining you?
What are the children ages?
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Attendance
Numbers of People Attending
Parent & Me Selfie Day at Werkit RVA selfie Museum; 12:30pm-2:30pm; Aug.13th
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Accommodations
Comments
Please Enter any questions or concerns that you dont see listed on the form
Medical & Photo Release Form.. It is recommended that participants secure adequate medical insurance to cover any injuries that may arise from participation in A Better Day Than Yesterday Initiative Programs( ABDTYIP). I hereby approve myself and/or my child’s participation in the program. I hereby consent to emergency medical treatment for my child on my behalf. In addition, I will assume any and all financial responsibility. To the best of my knowledge, there are no physical and/or other conditions, which would interfere with my child’s participation in such activities .I, the undersigned, hereby release A Better Day Than Yesterday Initiative Program from any liability or claims for injury, illness, or property damage that I sustain and/or cause during my participation, or sustained by my son/daughter/minor in my care participating in this event, program or other which is in any way related. I expressly accept and assume all of the risk inherent in this activity or that might have been caused by the negligence of Releases. Releases are defined as partners, sponsors, officers, members, agents, employees and any other organization, entities, and individuals who are serving A Better Day Than Yesterday Initiative Program including all volunteers assisting with programs, events or other ABDTYIP activities. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Release from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional misconduct. PHOTO RELEASE: I hereby give consent for ABDTYIP, to use photographs and/or videos of my minor child, to be used in its publications, including its website and/or social media. I release A Better Day Than Yesterday Initiative Program LLC. From any expectation of confidentiality or financial reimbursement on behalf of the aforementioned minor child and/or myself. Child Disclaimer and Signature: I certify that my answers are true and complete to the best of my knowledge.
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COVID - 19 Release I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that ABDTYIP has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that ABDTYIP can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families. I hereby release and agree to hold ABDTYIP harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from ABDTYIP. I understand that this release discharges ABDTYIP from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ABDTYIP. This liability waiver and release extends to the salon together with all owners, partners, and employees.
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