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2023 HBCU Send-Off Party Registration
Must be an incoming Freshman at an HBCU for Fall 2023
REGISTRATION DEADLINE: Tuesday, August 1st
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Name
*
First
Last
E-mail
*
Phone
*
Are you attending HBCU in Fall 2023
*
Yes
No
Name of HBCU attending in 2023
*
Proof of Enrollment
*
Click or drag a file to this area to upload.
* Upload a document from your college recognizing your enrollment for the Fall 2022 semester. Please sent JPEG, PDF or Word Doc.
T-shirt Size (Tees will be given to all incoming HBCU Freshmen attendees registered for this event)
*
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Photographic Release Consent
PHOTOGRAPHY, AUDIO, AND VIDEO RECORDING By attending the HBCU Send-Off Party, I acknowledge and agree that THE BREAKFAST KLUB, INC. has the right to use, edit, alter, publish, distribute, reproduce, broadcast, rebroadcast, or incorporate in any manner whatsoever, all or any portion of photographs, images, likeness, videos and audio (collectively, “Depiction”), of me or my participation in the Event (including my name, occupation, and employer, and social media profiles if I choose to upload them in my own discretion) for use in marketing materials and/or training materials and for internal use (“Materials”). In addition, I waive any right to inspect or approve the finished product wherein my Depiction appears. I irrevocably, grant to the BREAKFAST KLUB, INC. a nonexclusive, perpetual, worldwide, royalty-free right and license to use my Depiction and transfer, and assign to THE BREAKFAST KLUB, INC. all rights I may have, if any, in and to the Materials and all copyrights in the Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers. I understand that the Materials may be substantially edited, altered, rearranged, or modified. To the maximum extent permitted by law, I hereby waive any moral rights You may have in the Materials.
Agree
I hereby hold harmless, release and forever discharge THE BREAKFAST KLUB, INC. from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. *
WAIVER, RELEASE, AND INDEMNIFICATION
As a condition of my participation in this meeting or event, I, or my adult parent(s) or legal guardian(s) if I am under 18 years old, expressly waive any rights against and release and hold harmless THE BREAKFAST KLUB, INC. and any of its officers, directors, employees, members, volunteers, representatives, contractors, agents, legal successors, and assigns (collectively “THE BREAKFAST KLUB, INC. Releasees”) from and against any and all claims, suits, demands, losses, damages, expenses, or liability of whatever kind or nature (collectively “liability”), under any theory of law or equity, that may arise during or as a result of my presence at THE BREAKFAST KLUB, INC. HBCU Send-Off Party, including but not limited to any such liability related to or arising out of illness, injury, or death associated with infection of COVID-19 or complications, symptoms, or other effects resulting from contracting COVID-19. I and my adult parent(s) or legal guardian(s) will defend, indemnify, and hold harmless THE BREAKFAST KLUB, INC. Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorneys’ fees, fees and the costs of enforcing any right to indemnification under this agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities.
Agree
I and my adult parent(s) or legal guardian(s) agree to be bound by all terms of this event attendee waiver, release and indemnification form *
Phone
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