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IN CONSIDERATION of being permitted to participate in any way in Volunteer and/or Event Activities (collectively, the "Activities") I, for myself for personal representatives, assigns, heirs, and next of kin:

1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,

2. I UNDERSTAND THAT I MAY BE PARTICIPATING IN AN ACTIVITY WITH POSSIBLE RISKS TO MYSELF AND OTHERS, INCLUDING THE RISKS OF DEATH, SERIOUS BODILY INJURY, AND PROPERTY DAMAGE. I AM RESPONSIBLE FOR THE SAFETY OF MYSELF.

I HEREBY STATE, THAT TO THE BEST OF MY KNOWLEDGE, I AM IN GOOD PHYSICAL AND MENTAL CONDITION, AND UNDERSTAND HEARTS UNITED FOR GOOD, INC., A NORTH CAROLINA NON-PROFIT CORPORATION (“HEARTS UNITED”) HAS SAFETY PROCEDURES AND I UNDERSTAND SAID SAFETY PROCEDURES AND THOSE SAFETY PROCEDURES HAVE BEEN ADEQUATELY COMMUNICATED TO ME. I VOLUNTARILY ASSUME ALL RISK OF ACCIDENT OR DAMAGE TO MY PERSON OR PROPERTY WHICH MAY BE INCURRED FROM OR BE CONNECTED IN ANY MANNER WITH MY PARTICIPATION IN ACTIVITIES. I FURTHER UNDERSTAND THE ACTIVITIES OFFERED BY HEARTS UNITED, INCLUDING, BUT NOT LIMITED TO PROGRAMMATIC ACTIVITIES, INTERACTIONS WITH ANIMALS, AND ANY OTHER SERVICE ACTIVITIES PRESENT VARIOUS DEGREES OF RISK OF HARM AND UNDERSTAND HEARTS UNITED HAS NO MEANS OF EVALUATING MY FITNESS FOR PARTICIPATING IN ANY OF THESE ACTIVITES, and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest staff member immediately; and,

4. I HEREBY RELEASE HEARTS UNITED, ITS OFFICERS, DIRECTORS, EMPLOYERS, REPRESENTATIVES, AGENTS AND MANAGEMENT COMPANIES FROM ALL CLAIMS, DEMANDS, ACTIONS AND FROM ALL LIABILITY FOR DAMAGE, LOSS OR INJURY (OF WHATEVER KIND, NATURE OR DESCRIPTION) THAT MAY ARISE OUT OF, OR I MAY SUSTAIN, IN CONNECTION WITH THE ACTIVITIES. I FURTHER AGREE TO INDEMNIFY AND HOLD HEARTS UNITED HARMLESS, AS WELL AS ITS OFFICERS, DIRECTORS, EMPLOYEES, REPRESENTATIVES, AGENTS AND MANAGEMENT COMPANIES FROM ALL CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, INCLUDING ATTORNEY’S FEES, EXPENSES AND COSTS, OF MYSELF OR OF THIRD PARTIES (OF WHATEVER KIND, NATURE OR DESCRIPTION), WHICH MAY ARISE OUT OF, OR IN ANY MANNER CONNECTED WITH, OR CAUSED BY MY PARTICIPATION IN THE ACTIVITIES OR BY MY GUESTS OR AGENTS. THIS RELEASE AND INDEMNIFICATION SHALL BE BINDING UPON MY HEIRS, ADMINISTRATORS, EXECUTORS, AND ASSIGNS. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

I Agree

 

September 17, 2025

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information
Email Address
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Email Address
Second Participant's Signature*
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Email Address
Third Participant's Signature*
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Email Address
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Email Address
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Email Address
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Email Address
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Email Address
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Email Address
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Email Address
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
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IF THE HUG VOLUNTEER CANDIDATE IS UNDER 18 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN MUST ALSO SIGN BELOW. 

I am the parent or legal guardian of the minor Volunteer named above. I have the legal right to consent to and, by signing below, I hereby consent in all respects to the terms of this agreement. I authorize Hearts United for Good to obtain medical treatment for such minor and release it from liability in accordance with this agreement. 



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Email Address
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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