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Pompano Beach - Florida Children's Initiative Designation Opportunity
Together, we'll explore how we can nurture the resilience of our children, empower our youth, and inspire a passion for excellence in every aspect of their lives
Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Title/Position
Affiliation, Business, or Organization
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name the Community you live in
Number of Children 18 and younger in household:
Please Select
1
2
3
4
5
6
7
8
9
10
Area of Interest:
YES
NO
Family Strengthening
Community Building
Housing & Community Safety
Education
Social Issues
Children, Youth & Young Adults
Economic Empowerment
Other areas:
Terms & Conditions
*
I hereby agree and give my permission for Community Foundation of Broward, ISEE Group, members, and/or partners to record, film, photograph, audiotape, or videotape (referred to as 'Works')myself or activities
I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the images may appear in electronic form on the internet or in other publications. I agree that I will not hold the organizers, or its partners responsible for any harm that may arise from such unauthorized reproduction.
I waive, release, and discharge the event organizers, its partners, contractors, employees, directors, officers, agents, designees, legal representatives, etc. from any and all liability, including but not limited to liability arising from negligence or fault for demise, disability, personal injury, property damage, property theft, etc.
Date
I am over 18 years-of-age and I have read this waiver and am familiar with its content
*
Submit
Should be Empty: