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EVENTS
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Event registration form
DONATE
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contact us
GALLERY
REGISTER
Event registration form
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Children Shoe 1
Children Name
First
Last
Age Size
Shoe Size
Children Shoe 2
Children Name
First
Last
Age Size
Shoe Size
Children Shoe 3
Children Name
First
Last
Age Size
Shoe Size
Children Shoe 4
Children Name
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Last
Age Size
Shoe Size
Children Shoe 5
Children Name
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Last
Age Size
Shoe Size
Children Shoe 6
Children Name
First
Last
Age Size
Shoe Size
✴ Disclaimer: I/We, the undersigned, herby certify that I/we am/are the legal guardian of the above attendee(S). I hereby assume all the risks of participating in any/all activities associated with this event. I understand and agree that A Barry Safe Place, Inc. (hereinafter referred to as “ABSPI”) is free of Liability of or from any items I/my family may receive from a distribution. Items received are assorted, limited, and donated from business/companies and are not the ownership of APSPI. Not all participants will receive the same items. Received items may not be sold, bartered, exchanged nor raffled for any type of monetary compensation or exchange for services.
✴ Nondiscrimination: A Barry Safe Place, Inc. (ABSPI) complies with applicable Federal civil rights laws and does not discriminate, exclude nor treat individuals differently based on race, color, national origin, age, disability, or sex.
✴ COVID 19 ADVISORY: We are committed to giving you a peace of mind when you attend our events, your/our safety and well-being, remains top priority. ALL events adhere to CDC COVID-19 guidelines - including, but not limited to wearing mask/face covering, hand sanitizing, and social distancing at least6-6 feet apart. We will continue monitoring recommendations from the WHO, CDC, and elected officials to remain up-to-date on the latest information and safety protocols.✴ NON-DISCRIMINATION: A Barry Safe Place, Inc. (ABSPI) complies with applicable Federal civil rights laws and does not discriminated, exclude nor treat individuals differently based on race, color, national origin, age, disability, or sex.
✴ COVID 19 ADVISORY: We are committed to giving you a peace of mind when you attend our events, your/our safety and well-being, remains top priority. ALL events adhere to CDC COVID-19 guidelines - including, but not limited to wearing mask/face covering, hand sanitizing, and social distancing at least 6-feet apart. We will continue monitoring recommendations from the WHO, CDC, and elected officials to remain up to date on the latest information and safety protocols
Participant Consent, Release & Wavier of Liability
I understand by registering and attending an A Barry Safe Place, Inc. (hereinafter referred to as “ABSPI” sponsored event (s).
I am agreeing to the terms of this consent, release and waiver; both on the behalf of myself and my child(ren) who attend.
I permit & give permission for my child(ren) to attend and participate in activities associated with the ABSPI events.
I understand that ABSPI events will be run ABSPI respective officers, directors, agents, attorneys, representatives, successors, assigns and volunteers, they will oversee activities and the attending child(ren) to the best of their ability, the above mentioned parties shall not be held liable for injury or harm to my child(ren) of any kind which may occur.
I acknowledge & grant permission for my child(ren) and myself to be photographed, interviewed, audiotaped, or videotaped at ABSPI event(s). For said photographs, interviews, audio and/or video content to be used by the ABSPI as it deems fit, publication, exhibition, or reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by ABSPI and its affiliates and representatives. Images, photos and/or videos may be used to promote ABSPI in the future. You waive all rights to inspect or approve any photo, audio, or video recordings taken by ABSPI or the person or, its subsidiaries, affiliates, and their respective officers, directors, agents, employees, volunteers, agents, attorneys, representatives, successors and assigns entity designated to do so by ABSPI sole discretion.
I understand ABSPI shall own all intellectual property rights, if any, arising in connection therewith, and I further agree and acknowledge that neither myself nor my child(ren) shall receive (or be entitled to receive) any compensation from ABSPI for such usage. I acknowledge that my minor child(ren) under the age of 18 shall not attend ABSPI event without a parent, guardian or adult who is authorized to be responsible for my child(ren).
I understand minors under 18 are prohibited to attend ABSPI events without an accompanying adult under any circumstances. I understand that neither the ABSPI nor it’s volunteers or event attendees are responsible for the safety or maintenance of the facility(ies) where the ABSPI events are held.
REGISTRATION and SIGNATURE: signifies permission for photos, publicity, inclusion of a participant is notified in writing prior to events. Hold harmless and indemnify ABSPI its subsidiaries, affiliates, their respective officers, directors, agents, employees, volunteers, agents, attorneys, representatives, successors and assigns from against all liabilities, claims, suits, loss, damages, costs, expenses, personal injuries (including death), property, injuries, property losses or damages occasioned by, or sustained, incurred or arising out/in connection of the actions of participants in the course of activities related to ABSPI events. (including, but no limited to.) I hereby assume full RESPONSIBILITY related to participation in event(s).
I hereby assume full RESPONSIBILITIES related to the participation in events
I HAVE READ THIS CONSENT, RELEASE & WAIVER OF LIABILITY FORM IN IT’S ENTIRETY, FULLY UNDERSTAND IT’S TERMS & AGREE BY ACCEPTANCE. I FREELY AND VOLUNTARILY CONSENT WITHOUT ANY INDUCEMENT, ASSURANCE OR COERCION.
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