Big Latch On 2021 Registration
Please read and fill in form carefully.

If anything changes or you are unable to attend PLEASE reach out to Olivia Rice or PCBP at

This registration form automatically enters you in our event raffles.

Event Details:
Saturday, August 7, 2021
Old River Farms
8711 Old River Road, Burgaw NC
Name *
Email address *
Phone number (for raffle) *
How many in your party? *
List any food allergies and/or sensitivities.
How many in your party will drink coffee? *
If you want coffee, is your preference to iced or hot coffee?
Clear selection
How many in your party are under 8 years old? *
Of those, how many are under 2? *
Are you okay with everyone in your party being photographed? Photos may be used on PCBP social media and/or website. *
Are you interested in volunteering for the event? (Set up, breakdown, latch counter, Etc)
Clear selection
PLEASE READ AND AGREE OR DISAGREE WITH THE TERMS. IF YOU DISAGREE PLEASE DO NOT ATTEND THE BIG LATCH ON THIS YEAR, we look forward to seeing you at a future event. Due to the outbreak of the Coronavirus/COVID-19, we are taking extra precautions with all participants and families involved in the Port City Breastfeeding Project’s Big Latch On happening on August 7, 2021. We will also be implementing additional sanitation and disinfecting practices. Please read the following and agree or disagree with the terms. I agree that my family will not attend this event if I or anyone in my immediate family has any of the following symptoms: Fever, Fatigue, Dry cough or Difficulty breathing.I agree to the following:-I understand the above symptoms and affirm that I, as well as all household members will not attend with we have experienced the symptoms listed above within 14 days on the event. -I affirm that I, as well as all household members, will not attend if we have been diagnosed with COVID-19 within 30 days on the event. -I affirm that I, as well as all household members, will not attend the event if we have knowingly been exposed to anyone diagnosed with COVID-19 within 30 days of the event.-I affirm that I, as well as all household members, will not have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within 30 days of the event. -I understand that Port City Breastfeeding Project cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.By agreeing to the terms, I agree to each above statement and release Port City Breastfeeding Project from any and all liability for the unintentional exposure or harm due to COVID-19.Port City Breastfeeding Project agrees to abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions. *
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