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  • Heart Saver Hero Award

    Capital Region, PA Heart Walk
  • Today, many Americans feel helpless in emergencies, unsure how to administer CPR or afraid of causing harm. We want to recognize everyday heroes—bystanders, colleagues, nurses, and EMS providers—who have taken action and helped save lives. Thank you for performing the heroic act of CPR, a critical link in our chain of survival. Your actions have not only impacted your community but also contributed to the American Heart Association’s mission to improve survival rates through bystander CPR. Please complete this form to nominate a Capital Region, PA lifesaver for the Heart Saver Hero award, sponsored by UPMC & UPMC Health Plan.

    If you have any questions, contact Jen.Yesavage@heart.org 

     

  • Format: (000) 000-0000.
  • Were the rescuers trained through American Heart Association?
  • Nominator Information

  • Format: (000) 000-0000.
  • Are you an employee of the American Heart Association?
  • Sponsored By: 

  • I would like to volunteer for the follow shift(s):*
  • CONSENT. I acknowledge that I am volunteering for the American Heart Association, Inc. (“AHA”) in or at the 2024 MARKET Heart Walk. I agree that I will not be paid for my services and will not be covered by AHA’s insurance. I further agree that my volunteering may be terminated at any time by the AHA or by me.

    ASSUMPTION OF RISK. Volunteering in the Event involves potentially hazardous activities that may include risks such as, but not limited to, falls, contusions, pulled muscles, contact with participants and effects of weather. In consideration of being allowed to volunteer, I hereby expressly assume all risks, including personal injury and death arising out of my volunteering. I am solely responsible for my own health and safety and represent that I am physically fit and able to volunteer for the AHA. I further agree that I will not operate any automobile for any purpose related to my volunteering. I am also aware of the risk of the highly contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19), influenza and other infectious diseases (collectively, the “Disease”) and the risk that I may be exposed to or contract the Disease by engaging in the Event, which may result in serious illness.

    RELEASE AND INDEMNIFICATION. I agree, for myself, my heirs, executors and administrators, to not sue and to release, indemnify and hold harmless, the American Heart Association, Inc., its affiliates, officers, directors, volunteers and employees, and all sponsoring businesses and organizations and their agents and employees (collectively “AHA Parties”), from any and all liability, claims, demands and causes of action whatsoever, arising directly or indirectly out of my volunteering for the Event — whether it results from the negligence of the AHA, other attendees at the Event or from any other cause.

    PHOTOGRAPH AND RECORDING AUTHORIZATION. I authorize the use, copyright, or publication of my name, image, or voice from volunteering in the Event as may be captured by photograph or recording in any medium (“recordings”) for promotional purposes related to AHA’s mission and this Event, including illustration, promotion, or advertisement. As a condition of volunteering, I grant AHA a perpetual, irrevocable, worldwide, transferable, royalty- free, and non-exclusive license to use, reproduce, adapt, modify, publish, distribute, publicly perform, and create a derivative work from the recordings, including display on the AHA website, without any attribution or compensation, with the goal to promote and support the AHA mission. Examples of promotion and mission related activities include, but are not limited to social media, media relations, consumer relations, donor relations, and storytelling.

    This agreement is meant to be as broad and inclusive as permitted by the State in which the Event is conducted.

    If any portion of it is invalid, the balance will continue in full force and effect.

    BY SIGNING, I ADMIT THAT I HAVE READ AND UNDERSTOOD ALL THE TERMS OF THIS CONSENT, RELEASE AND INDEMNIFICATION, AND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE AHA.

    I have read, understood, and agreed to the terms of this agreement.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • FOR ANY VOLUNTEER UNDER THE AGE OF 18, A PARENT OR GUARDIAN MUST AGREE TO THE BELOW:

    I am the legal guardian of the Volunteer, and I hereby consent to his/her volunteering. I have read the foregoing Consent, Release and Indemnification and I hereby agree on behalf of myself and Volunteer to its terms.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: