2026 Brookings Family Bash Registration

Thank you for attending this years' FREE Brookings Family Bash event, hosted by Brookings Area United Way and Brookings County Mental Health Coalition. All activities and the family meal are provided for free, please support this event to continue in the future by completing this registration form.

*Only one registration form per family is required.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Number of ADULT family members attending with you?

Please include yourself in the # of adults attending

Number of CHILDREN attending with you?

Liability Waiver
I, the undersigned, in consideration of being permitted to attend and participate at a Brookings Area United Way event, I hereby release, waive, discharge, covenant not to sue, and hold harmless Brookings Area United Way, participants, promoters, advertisers, owners and lessees of premises used to conduct events, and each of them, their directors, officers, agents and employees, (collectively, the "Releasees") of and from any and all liability, to the undersigned, my personal representatives, assigns, and heirs, for any and all loss or damage and any claim or demands therefore in account of injury to the person or property arising out of or related to myself or guests and family accompaning me, participation at a Brookings Area United Way event, whether caused by the negligence of the releasees or otherwise.

Media Release Statement
I hereby grant Brookings Area United Way and Brookings County Mental Health Coalition permission to use my likeness, guests, or family accompaning me, in photographs and/or video in any and all of its publications, including Web space, and in any and all other media, whether now known or hereafter existing, controlled by Brookings Area United Way and the Brookings County Mental Health Coalition, in perpetuity, and for other use by the organization. I will make no monetary or other claim against the Brookings Area United Way or Brookings County Mental Health Coalition for the use of the photographs and/or video. I hereby grant the Brookings Area United Way and Brookings County Mental Health Coalitionthe right to video record and/or photograph me and use the clips and/or photographs in promotional purposes. I waive the right to inspect or approve the finished project, including written or electronic copy. Additionally, I waive any rights to compensation arising or related to the use of the videos for educational or promotional purposes. I hereby hold harmless and release the Brookings Area United Way and Brookings County Mental Health Coalition, the videographer, photographer, their offices, employees, agents, or designees from liability for a violation of any personal or proprietary right I may have in connection with use.

By typing my name, I confirm that I have read and understood the statements above and voluntairily agree to each of their terms.

Please Print Name in Full

First NameLast Name

Today's Date

Date

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