Hero Information Form

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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 Hero A Parent / Guardian An authorized caregiver / support personnel

Name of hero *

The hero is *

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

Hero’s birthday *

Hero’s age *

Where the hero lives

Street address *

City *

State *

Zip code *

Does the hero reside in a group home? *

Yes No

If yes, the home’s name & contact information

Contact information

Phone number *

This phone number belongs to *

The Hero A parent/guardian Other

Email address *

This email belongs to *

The Hero A parent/guardian Other

A little more

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

Yes No

If yes, the veteran’s relationship to the hero

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

Yes No

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 events I rely on public transportation I use Uber / Lyft Other

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 from the date of signature through December 31, 2026.

Date executed *

Person completing the form *

The participant with no guardian The legal guardian of the participant Other

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? *

Yes No

Section 3 of 3

Image Release

Valid from the date of signature through December 31, 2026.

Today’s date *

The person completing this form is *

An adult with no guardian The legal guardian of the participant Other

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 effective through December 31, 2026, and I agree to all of the terms above. *

Signature of participant or legal guardian — type full name *

Is your typed signature legally binding? *

Yes No

How will you submit your signed form? *

I will print this form and submit it to an XH board member with a written signature I will email a signed copy to xheroes2021@gmail.com

First, tell us who you are

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: