Everybody’s Here Sign Up Form

Name *

First Name

Last Name

Cell Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which time would you prefer to attend (We will do our best to accommodate you.) *

9:00 am - 11:00 am

11:00 am - 1:00 pm

1:00 pm - 3:00 pm

Waiver *

I freely waive all rights to any future claims against the Utah Hemophilia Foundation, volunteers, or representatives due to any unforeseen circumstance that may occur during the Adult Retreat I hereby grant the release of any film, video, or other photographic images of the members of my family for use by the Utah Hemophilia Foundation for fundraising, educational or other purposes.

I Agree

*

I certify that none of my family members have symptoms of Covid-19 and/or any other illness. If any member of my family experiences symptoms of any illness, we will NOT attend the Everbody’s Here event.

I Agree