Heart of the City Registration & Waiver

Heart of the City Registration & Waiver

Register for the Be The Proof Foundation Heart of the City program and complete the liability waiver.
Participant Information
Participant First Name
Participant Last Name
Date of Birth

MonthDayYear
Date
Age
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip Code
School Name
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Parent/Guardian Signature
Health & Wellness Questions
Do you have any medical conditions we should know about?
Are there any allergies?
Are you currently taking any medication?
Do you have any injuries or physical limitations?
Anything else we should know to help support your participation?
Program Interests
Program Interests
Liability Waiver
Waiver Acknowledgment
Participant Signature
Parent/Guardian Signature (if under 18)
Communication Opt-In
I agree to receive text messages from Be The Proof Foundation about programs, events, schedule updates, and opportunities
I agree to receive emails from Be The Proof Foundation about programs, community opportunities, wellness initiatives, and updates
Message and data rates may apply. Participants can opt out at any time.
Should be Empty:

Heart of the City Registration & Waiver

Participant Information

Parent/Guardian Information

Health & Wellness Questions

Program Interests

Liability Waiver

Communication Opt-In