County of Residence(Required) (please select) Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadson Gilcrest Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota Seminole St. Johns St. Lucie Sumter Suwanne Taylor Union Volusia Wakulla Walton Washington Other
Consent(Required) WAIVER AND RELEASE OF LIABILITY
I/We acknowledge that my/our participation as a volunteer in Better Families' Parents Night Out is on a strictly voluntary basis. I/We agree, on behalf of myself, my children, and my family, to release and forever discharge Better Families and FlourishNow, Inc., and any of their respective employees, agents, volunteers and representatives from any and all claims for any accidental injury, death, damages, or other loss of any kind that I, my/our children, or any member of my/our family may suffer or incur arising out of or related to my/our participation in or involvement with the Parents Night Out or other related Better Families Program. This release of liability includes any accident, injury, death, loss, or damages to my/our child(ren) as well as to other individuals or property which may result from my/our participation in Parents Night Out, any actions/omissions of the employees, agents, volunteers, and representatives of FlourishNow, Inc. and/or Better Families. Throughout the event, there may be activities, events, or media releases that could result in my/our child(ren) and/or me/us being photographed. I/we agree that Better Families and/or Flourishnow, Inc. may use these photographs in promotions for the program, publish them with local articles, or use them to produce videos. If I/we would NOT like to participate in activities such as these, I/we must notify Better Families, and they will ensure that my/our child is not photographed in the program.
I have read and agree to the terms above