Carlin Prom Registration

REGISTRATION IS NOW OPEN.


You are invited to
Nicklaus Children’s Hospital
Carlin Family Prom
(and Parent Reception)

Saturday, April 13 at 6 p.m.

Hyatt Regency Coral Gables
50 Alhambra Plaza, Coral Gables, FL 33134
 

NICKLAUS CHILDREN'S PATIENTS ARE INVITED TO BRING A GUEST WITH THEM TO THE PROM. PARENTS (UP TO 2 FAMILY MEMBERS) ARE INVITED TO ATTEND THE PARENT RECEPTION. PLEASE REGISTER FOR BOTH EVENTS USING THE FORM BELOW. 

  • PATIENT PROM: Hall of Ambassadors (1st Floor)
  • PARENT RECEPTION: Venetian Room (1st Floor)
  • HAIR/MAKE UP: Cordoba and Almeria (2nd Floor)
English - For more information contact Carmen Hidalgo a Carmen Hidalgo at 305.342.2320 or carmen.hidalgo@nicklaushealth.org
Spanish – Para mas informacion por favor contactar a Carmen Hidalgo a 305.342.2320 o carmen.hidalgo@nicklaushealth.org

Patient Information

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Patient Needs

Hold Harmless Agreement

Hold Harmless Agreement: I have read and agree to the content stated in the Event Release/Waiver/Hold Harmless Agreement.

Emergency Medical Treatment Agreement

Emergency Medical Treatment Form: The parents or guardians of patient understand that our son/daughter, may require immediate medical attention during the Carlin Family Nicklaus Children’s Prom, and that every measure will be taken to contact us should there be a need for medical treatment; however, should an immediate need arise, my child will be transported to the Nicklaus Children’s Hospital Emergency Department for treatment. A Consent for Treatment will be required at the time of registration.

Media Release Form

Media Release Form: By submitting this form, I hereby give my consent and authorization to Nicklaus Children’s Health System, Nicklaus Children’s Hospital, and Nicklaus Children’s Hospital Foundation, including its physicians, authorized technicians, employees, and authorized agents (collectively “NCHS”) to photograph, film, create digital images, video, interview, create sound recordings, or otherwise create media content (“Content”) of me child related to the Nicklaus Children’s Hospital Carlin Family Prom. I understand that such media content may include my face, image, likeness, voice, name and age.

The agreements and releases of consent presented above have been electronically signed by a parent, legal guardian or patient over 18 years of age: