Play Date Registration

Play Date Registration

Freddie Ford Family Foundation
Are you looking for a way to connect with other parents of children with autism and want your kids to play? Join us for a fun time letting your kids play and chat with other parents.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Phone Number*
Provide your phone number with area code.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which play date are you signing up for?*

11/2/24 - Gaming Fun at Bridgeton Trails Branch St. Louis County Public Library
How many people will be attending this event.*
Indicate the number of people who will be attending this event.
Child's Name*

First NameLast Name
Child's Age.*
Include your child’s age.
Child's Name

First NameLast Name
Child's Age.
Include your child’s age.
Child's Name

First NameLast Name
Child's Age.
Include your child’s age.
Where did you hear about this event?*

FacebookTwitterYouTubeOnline AdsInstagramSearch EngineReferralOther
Other Comments/additional information
Feel free to suggest ideas for future play dates or give a note to event planners.
NOTICE

Photos will be taken during this event and used by the Freddie Ford Family Foundation for promotional purposes. Your attendance at this event grants permission to use your image and likeness in promoting the mission of the Freddie Ford Family Foundation.

Liability Waiver and Release Agreement

I,{parentguardianName}, the undersigned parent or guardian of the minor child named {childsName}, {childsName31}, {childsName32} and any other child(ren) (“My Child(ren)) named above as attending or participating in the event, ” hereby agree to the following terms and conditions as set forth in this “Liability Waiver and Release Agreement” (“Agreement”), and make the indicated representations, in consideration of and as a condition of My Child's participation in the following identified program, event or activity (the “Activity”),
which Activity is being organized, produced, managed or permitted by Freddie Ford Family Foundation at the indicated location(s) (the “Location”) on or during the indicated dates.

Informed Consent and Acknowledgement I hereby give my approval for my child(ren)’s participation in any and all activities prepared by Freddie Ford Family Foundation during the selected activity above. In exchange for the acceptance of said child(ren)’s registration and participation in the above marked play date by Freddie Ford Family Foundation, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Freddie Ford Family Foundation and all its respective officers, agents, Board members, and representatives from any and all liability for injuries to said child(ren) arising out of traveling to, participating in, or returning from selected activities.

In case of injury to said child(ren), I hereby waive all claims against Freddie Ford Family Foundation including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in free play in a park and on the playground as well as in all sports activities, including basketball, soccer, running, etc. Some of these injuries include, but are not limited to, the risk of fractures, disolocations, sprains, bruises, scrapes, paralysis, or death.

Release of My Claims and Indemnity Agreement: In consideration of the above and of My Child(ren)’s participation in this Activity, I hereby waive, release, and forever discharge the Freddie Ford Family Foundation and its curators, officers, Board Members, agents, employees, volunteers, representatives, successors, and assigns (“Released Parties”) from and against any and all claims that I may have and that arise out of :

a) My Child(ren)’s participation in the Activity and that seek to recover for any injury to or death of My Child(ren), or for any damage, loss and expense suffered by My Child(ren), due to the negligence or fault of the Released Parties;

b) my being present at the Activity and that seek to recover for any injury to or death of My Child(ren), or for any damage, loss and expense suffered by me on behalf of My Child(ren), due to the negligence or fault of the Released Parties.

In addition to the foregoing, I agree to indemnify and hold harmless the Released Parties from and against any and all claims, damages, losses and expenses (including reasonable attorneys’ fees) that arise out of my or My Child(ren)’s participation in or attendance at the Activity and that are claimed to be due to the negligence or fault of the Released Parties.

Assumption of Risk: I understand that the Activity involves certain risks, hazards and conditions, including, but not limited to, those indicated above, that may be dangerous to My Child(ren)’s life, limb and property and that those risks, hazards and condition can arise in a variety of unforeseen or foreseeable ways, which may include:
bodily injury, death and/or property damage. With such knowledge of the risks and dangers involved I am allowing My Child(ren) to participate in the Activity and on my and My Child(ren)’s behalf agree to assume and do assume the risks associated with the Activity.

Laws of the State of Missouri: I understand and agree that this Agreement is governed by the laws of the State of Missouri. I further agree that if any part of this Agreement is determined to be unenforceable, all other parts shall be given full force and effect.

Acknowledgment: I certify that:

a) I am the parent or legal guardian of My Child(ren);

b) That I have read this Agreement;

c) I am relying wholly upon my own judgment about the risk of harm, injury or death to My Child(ren) due to My Child(ren)’s participation in the Activity;

d) I am over the age of 18;

e) I am not signing this Agreement based upon any oral representations, statements or inducements that have been made to me that are not stated in this Agreement:
and

f) am voluntarily signing this Agreement as my own free act fully intending for me and My Child(ren) to be legally bound by it.
Signature

Clear

Play Date Donation

USDDescription

Credit Card

Should be Empty: