CocoaCourageColoring | Dr. Robyn White

Please complete the form below to register for this free family event.

Parent's or Guardian's Name

First

Last

Contact Phone :

Contact Email Address :

Number of Adults Attending

Number of Children Attending

Child #1 Name

Child #1 Age

Child #2 Name

Child #2 Age

Child #3 Name

Child #3 Age

Child #4 Name

Child #4 Age

Child #5 Name

Child #5 Age

Child #6 Name

Child #6 Age

Emergency Contact Name

Emergency Contact Phone Number

Do you or your children have any food allergies or dietary restrictions?

Other special accommodations requested:

Assistance Not Guaranteed.

Cancer Connection : Our event honors those who have been impacted by cancer, and we'd love to acknowledge your family's journey if you'd like to share. (Select All That Apply)

Not Required.

Consent for Photography and Video

By registering, I consent to any photos or videos taken during the event, which may be used for promotional purposes by the event organizers.

Note: If you prefer not to be photographed, please inform the event staff upon arrival.

Waiver of Liability

I hereby release and hold harmless DRW Health Solutions LLC (Dr. Robyn White, DNP) and the Boys & Girls Club of Oak Harbor, as well as their officers, employees, and volunteers, from any liability, claims, or demands that may arise in connection with my or my family’s participation in this event, except in cases of gross negligence or willful misconduct. I understand that this waiver extends to all claims for injury, damage, or loss, regardless of cause, that may occur during or as a result of this event.

Parent or Guardian Name

By typing my name, I acknowledge and agree to the terms outlined above.