Burn Survivor Holiday Party Registration

Burn Survivor Holiday Party~

The holiday party is an opportunity for families of burn survivors to gather for lunch and celebrate the holiday season. Please confirm your attendance by RSVP through this application to ensure we can reserve food for you and your family. If your plans change and you are unable to attend, kindly inform us by December 1st. We are pleased to announce that Fire Station 45 on Friars Road will be hosting our event again this year. Please note that we will not be using Snapdragon Stadium parking lot this year. Further updates regarding parking arrangements will be provided by text closer to the event.

Burn Survivor First Name*
Burn Survivor Last Name*
Is Burn Survivor a Minor?*
- Yes
- No
Age*
Parent/Guardian First and Last Name*
Street Address*
City*
Zip Code*
Phone Number*
Email*
How did you hear about this event?*
Total Number of Guests Attending (Must be Immediate Family to Attend)*
Immediate family members are those you deem as your dependents in the same household.
Is this your first event with the Burn Institute?*
- Yes
- no
Photo Consent*
- I DO
- I DO NOT
CONSENT AND RELEASE OF LIABILITY* I authorize the Burn Institute to use photographs, videos and/or personal story to further their efforts to promote public awareness and support. I, or as the parent/legal guardian if the above named is a minor, permit the Burn Institute to use and publish photographs, video and/or personal story for publicity purposes including Burn Institute literature and social media. I also give permission for the Burn Institute to release such photographs, video and/or personal story to the news media and/or Burn Institute approved partners and/or conduct interviews for publication/airing to its listeners/viewers/readers. I understand that the Burn Institute is the owner of any photographs/video/personal story and or the likeness of the person identified above in perpetuity. The hereby agrees to hold harmless the Burn Institute, its officers, directors, trustees, managers, agents, and employees, from any liability resulting from or arising in connection with the taking, publication and release of the photographs or video of the undersigned pursuant to this agreement.

Our Mission is to educate and inspire communities to reduce burn injuries and empower those affected by burn trauma.

Burn Survivor Holiday Party Registration

Burn Survivor Holiday Party~

Imperial Valley, CA

San Diego, CA

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