Super Bowl Viewing Party Event

Event: Superbowl Viewing Party
Date: Sunday, February 2nd, 2020
Time: 6:00 PM to End of Game (Eastern Time)
Location: Barren Heights Community Center
Address: 11420 Watterson Court, Suite #800

Join the Barren Heights community to watch the football game of the year! We’ll be projecting the game at the Barren Heights Community Center. There will also be a sensory friendly environment with games and crafts for the kids!

We encourage you to get decked out in your team’s gear and bring along your favorite Super Bowl dish! (did we hear someone say buffalo chicken dip?!)

Please RSVP Below!

Family Members Attending
Add All Family Members that will be Attending.
Father/Husband's Name
First Last
Dad's T-Shirt Size
Dad's Email
Dad's Phone
Dad's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Mother/Wife's Name
First Last
Mom's T-Shirt Size
Mom's Email
Mom's Phone
Mom's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
# of Children Attending
Child 1
Child 1
First Last
Child 1: Gender
Child 1: T-Shirt Size
Child 1: Disability
Child 1: Specific Diagnosis
Child 1's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 2
Child 2
First Last
Child 2: Gender
Child 2: T-Shirt Size
Child 2: Disability
Child 2: Specific Diagnosis
Child 2's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 3
Child 3
First Last
Child 3: Gender
Child 3: T-Shirt Size
Child 3: Disability
Child 3: Specific Diagnosis
Child 3's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 4
Child 4
First Last
Child 4: Gender
Child 4: T-Shirt Size
Child 4: Disability
Child 4: Specific Diagnosis
Child 4's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 5
Child 5
First Last
Child 5: Gender
Child 5: T-Shirt Size
Child 5: Disability
Child 5: Specific Diagnosis
Child 5's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 6
Child 6
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Child 6: Gender
Child 6: T-Shirt Size
Child 6: Disability
Child 6: Specific Diagnosis
Child 6's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 7
Child 7
First Last
Child 7: Gender
Child 7: T-Shirt Size
Child 7: Disability
Child 7: Specific Diagnosis
Child 7's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 8
Child 8
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Child 8: Gender
Child 8: T-Shirt Size
Child 8: Disability
Child 8: Specific Diagnosis
Child 8's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 9
Child 9
First Last
Child 9: Gender
Child 9: T-Shirt Size
Child 9: Disability
Child 9: Specific Diagnosis
Child 9's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Child 10
Child 10
First Last
Child 10: Gender
Child 10: T-Shirt Size
Child 10: Disability
Child 10: Specific Diagnosis
Child 10's Food Restrictions, if any
(Allergies, Special Requirements, etc.)
Food
We encourage you to bring your favorite Super Bowl dish to this event!
Will you be bringing a dish with you to the event?*
- Yes
- No
What specifically will you be bringing?*
All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

Hold Harmless Agreement

By checking the boxes below you are agreeing on behalf of your family to an electronic signature.
Please check if you agree with the following statements:*
- I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
- I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by Barren Heights for training, promotion, and fundraising.
- I release Barren Heights, its directors, and volunteers, and the Community Center facility from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
- I understand that in order for everyone to experience a sense of calm, peaceful relaxation, the Community Center is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
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Family Members Attending

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Child 8

Child 9

Child 10

Food

Hold Harmless Agreement

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