City Stewards at Springfield Kids Dentist

Saturday, January 18, 2020
10:00 AM 11:00 AM 10:00 11:00

Springfield Kids Dentist 5895 Main Street Springfield, OR 97478 (map)

Google Calendar ICS

We will be meeting at Springfield Kids Dentist to help put together goodie bags for Affair of the Heart (a local vending event where proceeds benefit local community organizations).

Name

First Name

Last Name

How many people from your party will be attending?

WAIVER

I, the undersigned and/or parent/guardian of the individual(s) indicated above, do hereby agree to indemnify and hold harmless Little Hands Can and its agent from and against any and all liability resulting from participation in the events listed above. I understand that the event(s) in which I and my child(ren) are enrolling, like all activity programs, has some inherent risk, for which I agree to assume the liability. Furthermore, the individuals indicated herein are in good health appropriate for the activities in which they will be participating. Photo Release For Little Hands Can promotion purposes, photographs may be taken of participants. No names or any other identifying information will be shared if the photograph is used, unless requested. I hereby grant Little Hands Can permission to use my and my child(ren)'s likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based social media accounts, without payment or other consideration. If you do not wish to have your photo taken, please notify the photographer or LHC Representative at the event. Consent: I allow LHC to store my name and email to contact me regarding details for the event.

I agree