Kid Zone Registration

Kid Zone Registration

Porphyria Palooza 2026
Porphyria Palooza Kid Zone participants must be over the age of 3 and under the age of 18. Children are eligible to participate only if they are potty-trained.
How may children are you registering for the Porphyria Palooza Kid Zone?

Child 1 Information
Child's Name

First NameLast Name
Child's Preferred Name
Child's Pronouns (optional)
Child's Age (as of October 9, 2026)
Dietary Needs
Please list specific allergy/allergies
Pursuant to the Americans with Disabilities Act (ADA), does this child have any special needs or requirements?
Is there any additional information you would like to provide about your child?

Child 2 Information
Child's Name

First NameLast Name
Child's Preferred Name
Child's Pronouns (optional)
Child's Age (as of October 9, 2026)
Dietary Needs
Please list specific allergy/allergies
Pursuant to the Americans with Disabilities Act (ADA), does this child have any special needs or requirements?
Is there any additional information you would like to provide about your child?

Child 3 Information
Child's Name

First NameLast Name
Child's Preferred Name
Child's Pronouns (optional)
Child's Age (as of October 9, 2026)
Dietary Needs
Please list specific allergy/allergies
Pursuant to the Americans with Disabilities Act (ADA), does this child have any special needs or requirements?
Is there any additional information you would like to provide about your child?

Child 4 Information
Child's Name

First NameLast Name
Child's Preferred Name
Child's Pronouns (optional)
Child's Age (as of October 9, 2026)
Dietary Needs
Please list specific allergy/allergies
Pursuant to the Americans with Disabilities Act (ADA), does this child have any special needs or requirements?
Is there any additional information you would like to provide about your child?

Child 5 Information
Child's Name

First NameLast Name
Child's Preferred Name
Child's Pronouns (optional)
Child's Age (as of October 9, 2026)
Dietary Needs
Please list specific allergy/allergies
Pursuant to the Americans with Disabilities Act (ADA), does this childr have any special needs or requirements?
Is there any additional information you would like to provide about your child?

Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com

Consent
Consent to Participate

I, {parentguardianName}, hereby grant permission for:

{childsName}

{childsName16}

{childsName25}

{childsName33}

{childsName41}

to participate in Kid Zone at Porphyria Palooza.
Photography and Videography Release

United Porphyrias Association (“UPA”) may capture photographs and video during Porphyria Palooza 2026. By this release, I consent to the recording, videotaping, or photographing of my child/children's image(s) and/or voice.

UPA, perpetually and throughout the world, (a) in connection with any video, audio, or photographs taken in connection with Porphyria Palooza 2026, (b) in any related advertising, video or audio recordings, printed publications and Internet publications, and (c) in any other medium for a related purpose. I also consent to the use of my child/children's name in such media.

I acknowledge and agree that UPA, and its successors and assigns, is the sole owner of all copyrights, literary rights, and similar rights to such media. UPA agrees to preserve the integrity of my child/children's likeness, voice, and name.

By this release, I consent to the use of my child/children's likeness in such photograph(s) perpetually and for all media worldwide (including print, Internet, and any other electronic medium). I understand and agree that I shall receive no compensation for the use of my child/children’s likeness, voice, and name in such media.
Acknowledgment of Personal Responsibility

UPA is committed to providing a safe and healthy environment for all conference attendees, exhibitors, partners, and the administrative team.

With my response below, I release UPA and its Meeting Committee, Board of Directors, staff, and contractors from liability should I or my camper become ill, directly or indirectly, as a result of my participation in this event.

I am registering on behalf of the following child/children who are under eighteen (18) years of age:

{childsName}

{childsName16}

{childsName25}

{childsName33}

{childsName41}

I represent that I am the parent or guardian of such person(s). I hereby accept personal responsibility for myself and my child/children.
Signature
Should be Empty:

Kid Zone Registration

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Child 5 Information

Parent/Guardian Information

Consent