RSVP to Virginia Make A Difference Day 
Saturday, October 21, 2023 
All adults participating must register individually. Lead parent may register for all children.

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What is your first and last name ?  *
Cell Phone  *
Email *
How many people will be under this reservation?  *
Names of others attending in your family? 
Is there anyone under the age of 18? If so, type in the ages of each child separated by a comma ( eg. 5,8,10) *
Do you need T-shirts? If so, what sizes? (select the quantity for each size your family will need)
1 shirt
2 shirts
3 shirts
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL

Organizer: The Loukoumi Make A Difference Foundation, Inc./ Karins Florist

Date: October 21, 2023

Event: Loukoumi Good Deed Bus/Make A Difference with Loukoumi Day 


I hereby grant permission for my child to attend the Event on Saturday, October 21, 2023. I further agree on behalf of myself, my child, my family and any successors and assigns, to hold harmless, indemnify and defend the Organizer, its officers, directors, agents and any other representatives associated with the Event from any and all actions, claims, damages, demands, costs, expenses, and all consequential damage arising from or in connection with me or my child attending the Event or in connection with any illness or injury, or cost of medical treatment in connection therewith. I further grant my permission to the Organizer to use any photos taken at the Event on social media, or on the Organizer's website or in any other of Organizer’s materials. 
By signing my name below, I agree I have read and understand, and I have read to my children, and agree on behalf of myself and my minor children to be bound by the terms of this agreement. Type your name below as your binding signature 
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