REGISTRATION FOR 2022 ILLUMINATE LIGHT SHOW IS NOW CLOSED!!! Please try again in 2023
Illuminate Light Show Registration Form
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Illuminate Light Show and Mason's Toy Box Partnership
Parent or Guardian Name (First and Last) *
Parent or Guardian Phone (Include Area Code) *
Please acknowledge that you understand only families impacted by childhood illness and injury qualify for this show for FREE through Mason's Toy Box Foundation. If you do not qualify to see the light show through us and want to attend the light show, please find Illuminate Light Show on Facebook for details about how you can see the show.

DISCLAIMER: IF YOUR CHILD HAS A SEIZURE DISORDER AND SEIZURES TEND TO BE TRIGGERED BY BRIGHT LIGHTS, PLEASE UNDERSTAND THIS IS A 20 MIN DRIVE THROUGH BRIGHT LIGHTS THAT BLINK.

BE SURE TO HAVE SEIZURE MEDS WITH YOU IF YOU CHOOSE TO BRING YOUR CHILD TO THE LIGHT SHOW.
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Required
Contact Number (include area code) *
Email address *
Home Address (include city, state, zip) *
Do you have a child impacted by illness/injury?  *
Please tell us about your child's diagnosis and treatments *
How did you hear about Mason's Toy Box Foundation? *
Name, Gender, Age of qualifying child?  *
Please choose a date(s) available to attend at 5:30pm in Doswell, Virginia. You may choose more than one, we will email you confirmation of your scheduled date.

SPOTS ARE LIMITED. PLEASE CALL MTB AT 833-MTB-GIFT IF YOU CANNOT ATTEND YOUR SCHEDULED TIME OR ARE GOING TO BE LATE ARRIVING. 
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Required
Please read this form carefully and be aware in registering your minor child, you will be waiving and releasing all claims for injuries you or your minor child might sustain arising out of the any Mason's Toy Box (MTBF) gifts you receive or events you may participate in. I recognize and acknowledge that there are certain risks of physical injury to participants in the MTB events and/or gifts received from MTBF. I agree to assume the full risk of any injuries including death, damages or loss, regardless of severity, which I or my minor child(ren) may sustain as a result of participating in any and all activities connected with or associated with such event(s). I agree to waive and relinquish all claims I or my minor child may have against Mason's Toy Box, and its officers, directors, agents, servants, and volunteers as a result of participating in the event(s). I do hereby fully release and discharge Mason's Toy Box and its officers, directors, agents, servants, and volunteers from any and all claims from injuries, including death, damage or loss, which I or my minor child may have or which may accrue to me or my minor child(ren) and arising out of, connected with, or in any way associated with the activities of the event(s). I hereby authorize Mason's Toy Box to use my image, my child's (or children's) images, pictures, information about our families journey (to include medical information) in MTB events, or related activities in the group’s promotional material and/or on the Mason's Toy Box website, social medial platforms for marketing and promotional efforts at any point in the future. I agree to allow Mason's Toy Box to share pertinent information with other organizations and medical facilities as necessary, in an attempt to gain additional support for my family. I have read and fully understand the waiver and release of all claims and certify all information above is true and accurate. * *
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