La Crosse Pizza and a Movie

Saturday, April 15, 2017
3:00 PM 7:00 PM 15:00 19:00

Marcus Theatre 2032 Ward Ave La Crosse, WI (map)

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Join DSAW-La Crosse for our Pizza and a Movie event on Saturday, April 15th at Marcus Theatre.

WHO: Individuals with Down syndrome ages 13 and up.

WHAT: We will see Beauty and the Beast together, and then head to Pizza Hut for dinner! 2 chaperones will be provided (one male and one female). No transportation will be provided, however.

WHEN: Saturday, April 15, 2017. Times will be around 3pm - 7pm but are dependent on the movie time. TBD.

WHERE: Marcus Theatre
2032 Ward Ave, La Crosse

Self-Advocates should be dropped off at the movie theatre (we will meet in the lobby) and picked up at Pizza Hut. Exact times are still TBD.

COST: This is a FREE event for all individuals with Down syndrome, including movie ticket, soda, snack, and pizza afterwards. Caregivers, parents, and guardians are welcome to attend (however, not required), but we ask that they pay for their ticket, snacks, and pizza.

RSVP below by April 12:

Self-Advocate Name

First Name

Last Name

Self-Advocate Age

Any dietary restrictions?

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Parent/Guardian Email Address

Parent/Guardian Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

DSAW Waiver & Photography Consent

I, the participant, understand that during my participation in the April 15, 2017 Down Syndrome Association of Wisconsin La Crosse Pizza & a Movie Event (hereby referred to as the "event") organized by the Down Syndrome Association of Wisconsin-La Crosse and their officers, Board members, directors, employees, volunteers and agents (collectively, “Released Parties”) I may be exposed to a variety of hazards and risks, foreseen or unforeseen, which are inherent in eating and related activities and cannot be eliminated without destroying the unique character of the event. These inherent risks include, but are not limited to, the dangers of serious personal injury, death and property damage (“Injuries and Damages”) resulting from physical contact with others, equipment and facilities. I fully understand that the Released Parties have not tried to contradict or minimize my understanding of these risks. I know that Injuries and Damages can occur by natural causes or activities of other persons, other participants or volunteers or third parties, either as a result of negligence or because of other reasons. I understand the risks of such Injuries and Damages involved in the event and I appreciate that I may have to exercise extra care for my own person and for others around me in the face of such hazards. I further understand that there may not be medical personnel or medical facilities or expertise necessary to deal with the Injuries and Damages to which I may be exposed. In consideration for my acceptance as a participant in the event, and the services and amenities provided by the Released Parties in connection with the event, I CONFIRM MY UNDERSTANDING OF THE FOLLOWING: RELEASE OF LIABILITY. To the fullest extent allowed by law, I agree to WAIVE AND DISCHARGE CLAIMS AGAINST, RELEASE FROM LIABILITY, INDEMNIFY AND HOLD HARMLESS the Released Parties and their officers, Board members, directors, employees, volunteers and agents (collectively, “Released Parties”) from and against ANY AND ALL LIABILITY on account of, or in any way resulting from, my death or personal injury relating to my participation in the event, even if caused by NEGLIGENCE of the Released Parties. Such negligence could involve (a) negligent operation and supervision of the event, (b) negligent maintenance or operation of the site or facilities in which event is conducted, (c) negligent manufacture of or use of equipment to be used in the event, and (d) the negligent provision of emergency response services. I understand and intend that the assumption of risk and release is binding upon my heirs, executors, administrators and assigns. This Waiver and Release is intended to be as broad and inclusive as is permitted by law. If any provision or any part of any provision of this Waiver and Release is held to be invalid or legally unenforceable for any reason, the remainder of this Waiver and Release shall not be affected thereby and shall remain valid and fully enforceable. I have read this Waiver and Release of Liability in its entirety and I freely and voluntarily choose to participate and assume all risks of Injuries and Damages. I agree to obey any rules and regulations that may relate to the event. I acknowledge my waiver of any right I may have to bargain for different terms of this waiver and recognize that a narrower waiver would increase the costs associated with the event and/or limit or preclude my participation in the event. I certify that he or she is the parent or legal guardian of the minor who is participating in the event, consents to his or her participation in the event and executes this Waiver and Release of Liability on behalf of such minor. Consent to Photograph and Release of Name: I hereby authorize the Down Syndrome Association of Wisconsin-La Crosse, and their officers, Board members, directors, employees, volunteers and agents (collectively, “Released Parties”) to photograph, film, or videotape. I hereby agree the Released Parties, collectively or individually, may use such photographs, films or videotapes, with or without prior notice, in general public relations, communications or for commercial purposes. I understand this Consent to Photograph is a valid written consent for purposes of Wis. Stat. § 995.50 and any other similar local, state or federal law regarding a right to privacy. I hereby authorize the Released Parties to use in writing or otherwise the name or identity of the participant. I release the Released Parties from any liability involved with this Consent to Photograph or Release of my Name.

Yes, I agree

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