Consent Form

Please read this consent form carefully and provide your agreement to the terms outlined below. All fields marked with * are required.

Full Legal Name *

Date of Birth *

Email Address *

Phone Number *

Current Address *

Are you 18 years of age or older? *

Yes

No

If under 18, Parent/Guardian Full Name

If under 18, Parent/Guardian Email

If under 18, Parent/Guardian Phone Number

Purpose of Consent - Please describe what you are consenting to *

I consent to participate in the described activity/service/study *

Yes, I consent

No, I do not consent

I have been informed of and understand the nature and purpose of this activity *

Yes, I understand

No, I need clarification

I have been informed of any potential risks or benefits *

Yes, I have been informed

No, I have not been informed

I understand that my participation is voluntary and I may withdraw at any time *

Yes, I understand

No, I do not understand

Medical Information Consent - I consent to share relevant medical information (if applicable)

Yes, I consent

No, I do not consent

Not applicable

Please list any medical conditions, allergies, or medications we should be aware of

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

Photography/Video Release - I consent to being photographed or recorded *

Yes, I consent to all photography/video

Yes, but only for internal use (not public)

No, I do not consent to photography/video

I consent to the use of my image in promotional materials, social media, or publications

Yes, I consent

No, I do not consent

Not applicable

Audio Recording Consent - I consent to audio recording

Yes, I consent

No, I do not consent

Not applicable

Data Collection & Privacy - I consent to the collection and storage of my personal information *

Yes, I consent

No, I do not consent

I understand how my personal information will be used and protected *

Yes, I understand

No, I need clarification

I consent to being contacted for follow-up purposes

Yes, by email

Yes, by phone

Yes, by either method

No, please do not contact me

Communication Consent - I consent to receive emails, newsletters, or updates

Yes, I consent

No, I do not consent

Third Party Sharing - I consent to my information being shared with authorized third parties

Yes, I consent

No, I do not consent

Not applicable

Liability Waiver - I understand and accept any risks associated with this activity *

Yes, I understand and accept

No, I do not accept

I agree to release and hold harmless the organization from any liability *

Yes, I agree

No, I do not agree

I have read and understand all terms and conditions *

Yes, I have read and understand

No, I need to review again

I have had the opportunity to ask questions and receive answers *

Yes

No, I have questions

If you have questions or concerns, please list them here

I certify that all information provided is true and accurate *

Yes, I certify

No

Consent Form

Full Legal Name *

Date of Birth *

Email Address *

Phone Number *

Current Address *

Are you 18 years of age or older? *

If under 18, Parent/Guardian Full Name

If under 18, Parent/Guardian Email

If under 18, Parent/Guardian Phone Number

Purpose of Consent - Please describe what you are consenting to *

I consent to participate in the described activity/service/study *

I have been informed of and understand the nature and purpose of this activity *

I have been informed of any potential risks or benefits *

I understand that my participation is voluntary and I may withdraw at any time *

Medical Information Consent - I consent to share relevant medical information (if applicable)

Please list any medical conditions, allergies, or medications we should be aware of

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

Photography/Video Release - I consent to being photographed or recorded *

I consent to the use of my image in promotional materials, social media, or publications

Audio Recording Consent - I consent to audio recording

Data Collection & Privacy - I consent to the collection and storage of my personal information *

I understand how my personal information will be used and protected *

I consent to being contacted for follow-up purposes

Communication Consent - I consent to receive emails, newsletters, or updates

Third Party Sharing - I consent to my information being shared with authorized third parties

Liability Waiver - I understand and accept any risks associated with this activity *

I agree to release and hold harmless the organization from any liability *

I have read and understand all terms and conditions *

I have had the opportunity to ask questions and receive answers *

If you have questions or concerns, please list them here

I certify that all information provided is true and accurate *

Electronic Signature (Type your full name) *

Today's Date *

Parent/Guardian Signature (if applicable - Type full name)

Parent/Guardian Date (if applicable)

Additional Comments or Notes