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Consent, Release, and Indemnification

Please sign below


Thank you for allowing your child to participate in the ľ¹ÏÖ±²¥.’s (“AHA”) youth volunteer initiatives, which support the mission of the ľ¹ÏÖ±²¥ to be a relentless force for a world of longer, healthier lives. This commitment will include online training, service projects that include posting online, teleconferences and online surveys about volunteer experiences. I hereby expressly assume all risks, including personal injury and death, arising in any way out of my child’s participation in the Event and any related activities and services offered at the Event in which my child voluntarily participates.

I understand and agree that: 

My child is able to participate in related activities and services and  agrees to stop participating if they become uncomfortable continuing at any point. My Child or I can choose to stop participating at any time.

I agree, for myself, my heirs, executors and administrators, to not sue and to release, indemnify and hold harmless, the ľ¹ÏÖ±²¥., its affiliates, officers, directors, volunteers and employees, and all sponsoring businesses and organizations and their agents and employees (collectively “AHA”), from any and all liability, claims, demands and causes of action whatsoever, arising directly or indirectly out of my participation in this event and related activities and services — whether it results from the negligence of any of the above or from any other cause.

I authorize the use, copyright, or publication of my name, image or voice from participating in the Event and related activities, as may be captured by photograph or recording in any medium for any purpose, including illustration, promotion, or advertisement.   As a condition of participation, I grant AHA a perpetual, irrevocable, worldwide, transferable, royalty-free, and non-exclusive license to use, reproduce, adapt, modify, publish, distribute, publicly perform, create a derivative work from, and publicly display this activity, including display on the AHA website, without any attribution or compensation.

I agree that AHA may use and share personal information about me that I give AHA, that I may have given to AHA previously, that AHA collects through its websites, apps, social media sites, devices, as well as the information about me that AHA combines with that collected by others.

AHA uses and shares my personal information to fulfill AHA’s mission to be a relentless force for a world of longer, healthier lives, to notify me of donor opportunities and offer me products and services, to provide me with products or services that I request, and to improve AHA’s programs and websites.
I can learn more about how AHA uses, shares, and protects my personal information by reading the .

If I am registering a child under the age of 18 or an incapacitated adult I represent and warrant that I am the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration.

This agreement is meant to be as broad and inclusive as permitted by the State or Province in which the event is conducted. If any portion of it is invalid, the balance will continue in full force and effect.



Please provide the Child's First Name.

Please provide the Child's Last Name.

Please provide the Child's Birthday.

Please provide Parent/Guardian Name.

Please provide Parent/Guardian Initials.

Please specify the date.

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