Oct 20th FriendsDay Wed @ Cafe Cultivate

Name: Oct 20th FriendsDay Wed @ Cafe Cultivate
Start: 2021-10-20T18:00:00-07:00
End: 2021-10-20T19:30:00-07:00
Location: Cafe Cultivate

October 20, 2021 @ 6:00 pm - 7:30 pm Free

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ALL EVENTS

FRIENDS-DAY WEDNESDAY
Coffee & Chill at Cafe Cultivate

REGISTRATION IS REQUIRED

October 20th | 6:00 – 7:30 PM
REGISTRATION CLOSES 10/14 @ 11:59 PM

5025 E. Washington Street
Phoenix, AZ 85034

Registered participants will receive information in advance to order their own food through Café Cultivate. (1) food choice and any sides/deserts that food choice comes with and (1) specialty drink. Additional food/drinks will be at your own cost.

Registration is also required for Family/Caregivers that need to be there due to transportation. You will receive information in advance to pre-order and pay for your own food through Café Cultivate. Family/Caregivers will sit in a separate area to give survivors social time.

If you are arranging public transportation, please make sure to have your ride arranged for a pickup no later than 7:30 pm, as we cannot guarantee anyone will be there after that time.

— IMMEDIATE FAMILY —

For those events specified as "family friendly" and where attendee may participate as "Immediate Family"

Immediate family is described as the survivor’s parents, spouse, siblings, and children.

By registering for any WMF activity/event,

I acknowledge that refunds will not be given for cancellations after the activity/event’s applicable registration deadline.
I understand that WMF reserves the right to invoice me for cancellations after the registration deadline
I understand that if I am a NO-SHOW, WMF may invoice me or reimbursement for the amount that was paid on my behalf.
I understand that I am required to complete a WMF Waiver of Release and Liability each year which includes emergency contact information (along with a COVID-19 Waiver & Release as applicable) in order to participate in activities and events.
I also agree to abide by WMF’s Code of Conduct.

Please read and acknowledge the Code of Conduct for We're Moving Forward! event participation / participants.

You will receive a copy of the Code of Conduct and your acknowledgment.

NOTE: If you are registering for more than just you, EACH ATTENDEE MUST READ, ACKNOWLEDGE AND COMPLY with the Code of Conduct.

We believe our community should be truly open for everyone. As such, we are committed to providing a friendly, safe and welcoming environment for all, regardless of gender, sexual orientation, disability, ethnicity, or religion.

This code of conduct outlines our expectations for participant behavior, as well as the consequences for unacceptable behavior.

Participants will:

Be considerate, respectful, refrain from demeaning, discriminatory or harassing behavior, materials and speech.

Be responsible for their own safety. If mobility, cognitive, vision or other issues can be foreseen putting any participant at risk, it is the Participants obligation to have a responsible caregiver attend activities with them to assist with their needs and safety.

Be mindful of your surroundings and of your fellow participants. Alert organizers if you notice a dangerous situation or someone in distress.

Participants will not:

If under the age of twenty-one, will not consume, distribute, or possess alcohol while participating in any event.

Attend any event while intoxicated or under the influence of illegal substances.

Consume, distribute, or possess drugs that are a violation of the law.

Taunt, harass or physically confront any participant or other person at an event.

Damage or destroy any facilities or personal property of others at an event.

VIOLATIONS: Participants that fail to abide by this Code are subject to disciplinary action.

Anyone asked to stop unacceptable behavior is expected to comply immediately.

If a participant continues to engage in unacceptable behavior, the organizers may take any action they deem appropriate, up to and including expulsion from the event and possible future events without warning or refund.

ACKNOWLEDGEMENT*

I have read and agree to comply with the Code of Conduct

FULL NAME*

Email address*

This field should be left blank

NOTE: IF YOU HAVE ALREADY COMPLETED, SIGNED, AND MAILED/E-MAILED THE PDF 2021 WAIVER/RELEASE FORM, YOU DO NOT NEED TO COMPLETE THIS FORM. IT IS VALID UNTIL 12/31/2021.

This is a 2-part process:

Complete and submit the Participant Information form (below)
The Waiver of Liability, Media Release Agreement form will be emailed to you as a PDF attachment. Please complete and return the signed document per the address information provided on the form.

PARTICIPANT INFORMATION FORM

NAME

First

Last

EMAIL ADDRESS*

Best phone # to reach you*

Alternate Phone*

EMERGENCY CONTACT (required)*

First

Last

Email address for Emergency Contact*

Emergency Contact Phone*

Best contact number for your emergency contact

Address

City*

State*

Zip

If other, please specify:

SURVIVOR: Type of Brain Injury

Examples: TBI – Auto; TBI – Fall; ABI – Stroke; ABI - Tumor

Date of Injury

ADDITIONAL INFORMATION

Please note any other pertinent information we should know about:

Waiver & Release of Liability, Media Release Agreement

It is mandatory for all participants to complete, sign, date and submit the Waiver and Release of Liability, Media Release agreement forms. A copy of these forms will be sent to you as part of your confirmation email.

This field should be left blank

As may be required, please download, print out, complete and mail the COVID-19 Waiver and Release form (below).

Completed / signed forms may also be scanned and emailed to info@wmforward.org