Have you signed up a hero before?

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Your hero sign-ups

Section 1 of 3

Hero Information

About you & your hero

Name of person completing this form *

Are you… *

A HeroA Parent / GuardianAn authorized caregiver / support personnel

Name of hero *

The hero is *

An adult with no guardianAn adult with a guardian (unable to legally sign)A minor

Hero’s birthday *

Where the hero lives

Street address *

City *

State *

Zip code *

Does the hero reside in a group home? *

YesNo

If yes, the home’s name & contact information

Contact information

Phone number *

This phone number belongs to *

The HeroA parent/guardianOther

Email address *

This email belongs to *

The HeroA parent/guardianOther

A little more

Are you (Hero) or anyone in your family a veteran? *

YesNo

If yes, the veteran’s relationship to the hero

Any allergies, medical conditions, behavioral issues, or other limitations that may affect participation? *

YesNo

If yes, please describe

What are the hero’s interests or special talents? *

What are the hero’s transportation needs to attend events? *

I have reliable transportation to and from eventsI rely on public transportationI use Uber / LyftOther

Emergency contacts

Please provide at least two emergency contacts for the hero.

Emergency contact 1

Name *

Phone *

Relationship *

Emergency contact 2

Name *

Phone *

Relationship *

Section 2 of 3

Participant Release & Waiver of Liability

Valid for one year from the date it is signed.

Date executed *

Person completing the form *

The participant with no guardianThe legal guardian of the participantHouse managerOther

Participation & Consent

I give my consent to the participant’s participation in all activities of Xceptional Heroes. The participant and/or guardian is responsible for the participant’s insurance coverage in the event of personal injury or illness resulting from participation.

Waiver & Release

I release, forever discharge, and hold harmless Xceptional Heroes and its successors, sponsors, members, representatives, agents, employees, volunteers, and organizers from any and all liability, claims, and demands arising from the participant’s activities — including claims arising out of negligence, and covering bodily injury, personal injury, illness, death, or property damage.

Insurance

I affirm the participant is covered by primary medical insurance and that I am responsible for the participant’s medical bills if injury occurs. Xceptional Heroes does not assume responsibility to provide medical, health, or disability benefits.

Assumption of Risk

I understand the activities may be inherently dangerous to the participant. I expressly assume the risk of injury or harm and release Xceptional Heroes from all liability for injury, illness, death, or property damage resulting from these activities.

Medical Treatment

I release Xceptional Heroes from any claim arising from first-aid or medical services rendered during an emergency, and I consent for Xceptional Heroes to provide, administer, or obtain medical treatment for the participant.

Governing Law

This release is intended to be as broad and inclusive as permitted by Michigan law and is governed by Michigan law. If any provision is deemed invalid, the remaining provisions remain enforceable.

I have read and CONSENT to all of the statements above, knowingly and voluntarily. *

Sign — type your full legal name *

Is your typed signature legally binding? *

YesNo

Section 3 of 3

Image Release

Valid for one year from the date it is signed.

Today’s date *

The person completing this form is *

An adult with no guardianThe legal guardian of the participantHouse managerOther

By agreeing, I confirm each of the following:

I authorize Xceptional Heroes to edit, change, copy, and make any use of all images of the participant for promotional materials.
I acknowledge I will not be entitled to payment or any charge for such use.
I authorize use of the participant’s image, name, voice, or likeness for lawful purposes (internet, promotional, educational, marketing, etc.).
Upon such use, the materials become the sole property of Xceptional Heroes and I am no longer entitled to them, for lawful purposes.
I release all rights to any claims, demands, or causes of action by me, my representatives, heirs, or anyone else.
I waive my right to any royalty or compensation for the use of the images, name, voice, or likeness referenced here.

This release is valid for one year from the date it is signed, and I agree to all of the terms above. *

Signature of participant or legal guardian — type full name *

Is your typed signature legally binding? *

YesNo

Hero Information Form

Have you signed up a hero before?

First, tell us who you are

Step 1 of 2: Create your account

Sign in

Your hero sign-ups

Hero Information

Emergency contact 1

Emergency contact 2

Participant Release & Waiver of Liability

Participation & Consent

Waiver & Release

Insurance

Assumption of Risk

Medical Treatment

Governing Law

Image Release

By agreeing, I confirm each of the following: