Fashion Gives Back Silent Auction

Making a donation to the exclusive luxury silent auction offers the unique opportunity of showcasing your business and products to more than 400 of South Florida’s young professionals, all while supporting Nicklaus Children’s Hospital. Your donation will make a great addition alongside our many designer brands, luxury travel packages, and fine dining experiences. It’s only with the help of a caring community that we bring children better outcomes, better health and brighter futures.

For more information on our silent auction, please contact Morgan Waisner at 786.624.2823 or

Patient Information

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Patient Needs

Disclaimers and Agreements

Hold Harmless Agreement

This is to certify that we, the parents or guardians of my child, together with our heirs and legal representatives, release and discharge Nicklaus Children's Health System, its employees, agents, directors, officers, affiliated entities and other representatives, of and from any and all claims, demands, rights and causes of action of whatever kind and nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen causes of action that may be sustained by us or our son/daughter/s, as a consequence of our attendance at Carlin Family Nicklaus Children’s Prom. As a further and additional consideration for such, we agree to indemnify Nicklaus Children's Health System against loss from any and all further claims, demands and actions at law or in equity that may hereafter at any time be made or brought by us or anyone on our behalf for the purpose of enforcing a further claim for damages on account of our and our daughter’s attendance at Carlin Family Nicklaus Children’s Prom. This consent will remain valid until we cancel it in writing. Note: The above Agreement includes services provided by NCHS and respective sponsor, vendors and service providers, including but not limited to: make–up, hair styling and wardrobe.

Emergency Medical Treatment Agreement

Parents are welcome to stay on the even premises in a designated parent reception area while your child attends the event. Should your child require scheduled medication and/or medical intervention (i.e. suction, aerosol, etc.), we require that you bring any and all required medication and any medical supplies for your administration in a designated area which will be made available to you and your child.

We, the parents or guardians understand that our son/daughter, may require immediate medical attention during the Carlin Family Nicklaus Children’s Hospital 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.

Photo and Video Release Consent

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, fi lm, create digital images, video, interview, create sound recordings, or otherwise create media content (“Content”) of me/my child related to the event identified above or treatment of my/my child’s medicalcondition(s), including any operative or special procedures performed, for the purposes indicated in this consent.I understand that such media content may include my/my child’s face, image, likeness, voice, name, age, any and all information regarding my/my child’s medical condition(s), treatment, status, prognosis, and other protected health information as defi ned by the Health Insurance Portability and Accountability Act (HIPAA) as amended, and other federalor state privacy laws. I hereby consent to and specifically authorize NCHS to disclose and use such Content as indicated:

The Content may be used by NCHS for purposes of medical education, study and training, including possible publication in scientific or professional journals, articles, orother publications. Disclosures may be made to physicians,residents, fellows, medical students, affiliated academic andeducational institutions, local and national medical, scientifi c,and educational entities and groups, and any source formedical education purposes.

The Content may be used by NCHS for internal and external marketing, public relations, communications, andpromotional purposes. Disclosures may be made to national and local reporters, television programs, news agencies, radiostations, internet and social marketing or media sites.

I understand the Content and any and all reproductions of the Content obtained or created by NCHS remains the property of that NCHS entity. Any Content created by external media remains the property of that external media, unless otherwise agreed. All Content disclosed in reliance on this consent may be re-disclosed to other parties and may no longer be protected by state or federal privacy laws. I hereby agree to hold NCHS free and harmless from any and all liability arising out of the use and/or release of Content. I understand I may refuse to sign this consent, and that my refusal to sign will not affect in any way my or my child’s ability to obtain treatment at NCHS or any of its sites. I understand that NCHS is not requiring me to sign this consent as a condition to getting treatment, making payments on any bills, or gaining enrollment or eligibility in any health insurance plan, unless the Federal Privacy Regulations allow it. I realize that I /my child will not be compensated in any way by NCHS for providing, participating in, or consenting to use of Content. I understand that I may revoke this authorization at any time, provided I do so in writing and send such writing to NCHS, attention: Marketing Department. I understand that any Content disclosed between the effective date of this consent and the date of my revocation may still be used by NCHS. This consent shall remain in full force and effect as of the effective date below, unless and until a written revocation is received by NCHS.

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