• Bleeding Disorders of Kentucky Fall Family Enrichment Event

    Bleeding Disorders of Kentucky Fall Family Enrichment Event

  • The Bleeding Disorders of Kentucky Foundation is excited to announce it's sixth Fall Family Event on Saturday, October 10th!  Join us at the Newport Aquarium in Newport, KY for education, networking, and a whole lot of fun! Admission to the aquarium, lunch, and hotel stay for those residing two or more hours away is included.  This special day is all about supporting each other, learning together, and celebrating the strength of our community. We look forward to sharing it with you!

    **PLEASE NOTE:  There is a $15 registration fee, PER FAMILY, that secures your spot at the event.  This includes hotel stay (if applicable), lunch, and admission to the aquarium.  Refunds will be provided for those that cancel prior to October 1st.**

  • Application Deadline: September 25, 2026

    Space for this event is limited! Please complete your application in full as soon as possible to reserve your family's spot.
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  • BDoKY Fall Family Enrichment

    Event Application

  • DATE:  October 10, 2026

    LOCATION:  NEWPORT AQUARIUM
    1 AQUARIUM WAY
    NEWPORT, KY 41071

     

  • Today's Date:
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  • *Do you reside 2 or more hours away from Newport, KY?*
  • *If yes, are you interested in having a hotel room reserved for your family? (Friday night hotel stay included)*
  • *Do you reside more than 3 hours away from Newport, KY?*
  • *If yes, are you interested in having a hotel room reserved for your family? (Friday and Saturday night hotel stay included)*
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  • Alternate or Emergency Contact (outside the home):

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  • Would you be interested in receiving future event information and newsletters from the Bleeding Disorders of Kentucky Foundation?
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  • Family Member Medical Form

  • Date
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  • Below, please provide the total number of family members attending and requested medical information.

    We request ONLY family members residing in the household of the individual with a bleeding disorder attend the event.

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  • Waiver and Consent Form

  • Authorization and Acknowledgment: By signing this waiver and consent, I, the legal parent/guardian grant permission for myself/my children to participate in any and all activities as part of the bleeding disorders family event. I recognize and acknowledge the inherent risks that may present for myself/children including but not limited to: falls, trips, uneven ground, weather, bleeding events.  

    I acknowledge that the possession or use of alcoholic beverages and illegal drugs are strictly forbidden at any Bleeding Disorders of Kentucky (BDoKy) event. I understand the possession of any weapon (firearm, knife, explosives, or any other item which BDoKY may determine, in its sole discretion, is a weapon) is strictly forbidden  at the event facility. I authorize  (BDOKY) to release my demographic information to supporting affiliates who help with the cost of our family participating in the sponsored activities.  I agree to RELEASE and HOLD HARMLESS BDOKY, the facility, its founder, trustees, directors, officers, employees, agents, affiliates, volunteers and medical staff (“Staff”) from any and all injury claims of any other nature which may result from my participation and my children's participation at the event, including travel to or from the event. I agree to indemnify and hold the staff and other children at the event harmless from any and all liability caused by my children, whether or not intentional.

  • Medical Consent: I give my permission for BDOKY and medical staff to administer any emergency medications needed and to provide and arrange for any necessary medical treatment, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.*
  • Photography Release: In consideration of our participation during the family program, and without any further consideration from BDOKY, I hereby grant permission to the BDOKY, staff and affiliates to utilize my appearance, performance or voice in any and all manner and media for the purpose of promotion, reporting or publication. BDOKY may use our families’ photograph, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph.*

  • Please contact the UK or ULP HTC social worker before signing if you have questions.

    I have read this form carefully and have had all questions answered before signing this legal document and giving the consents and waivers contained in it. I acknowledge that this is a legal document and that any questions I have of a legal nature should be directed to my attorney. I further acknowledge I will be bound by my agreement to its terms. I represent to BDOKY that all information provided in this application and the medical information  is accurate and complete and that I have the legal authority to provide consent on behalf of my children and family.

  • Patient/Patient's Guardian must sign.  

  • Date:
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      Fall Family Enrichment Program Registration Fee

      $15.00 Fee Per Family

      $15.00$15.00
        
      Total
      $0.00$0.00

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