2022 Step Forward Day Of Registration

Step Forward to Prevent Suicide Registration Form

Thank you for attending the Bridging Yankton and Helpline Center's suicide prevention and awareness event. Please fill out the below form.
Name*

First NameLast Name
Email*
example@example.com
Attendees Under 18 Years Old
I, FOR MYSELF, MY HEIRS, PERSONAL REPRESENTATIVES, AND ADMINISTRATORS, HEREBY WAIVE, RELEASE, DISCHARGE, AND AGREE TO HOLD HARMLESS, THE HELPLINE CENTER, ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, AND VOLUNTEERS FROM ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES (INCLUDING COSTS) THAT I MAY HAVE FOR ANY AND ALL INJURIES I MAY SUFFER IN CONNECTION WITH MY VOLUNTARY PARTICIPATION IN THIS EVENT.

IF PARTICIPANT IS A MINOR, THEN HIS/HER PARENT OR LEGAL GUARDIAN MUST AGREE TO THE FOLLOWING: I AM THE PARENT OR LEGAL GUARDIAN OF A MINOR PARTICIPANT, AND I HEREBY CONSENT TO HIS/HER PARTICIPATION IN THIS EVENT. I HAVE READ THE FOREGOING RELEASE AND INDEMNIFICATION AGREEMENT, AND I HEREBY AGREE TO ITS TERMS ON BEHALF OF MYSELF AND THE MINOR PARTICIPANT.

I ALSO GIVE THE HELPLINE CENTER THE RIGHTS TO USE MY IMAGE OR LIKENESS OR, IN THE EVENT OF A MINOR PARTICIPANT, THE MINOR PARTICIPANT'S IMAGE OR LIKENESS, IN PROMOTIONAL MATERIALS FOR FUTURE EVENTS OR FOR ANY OTHER PURPOSE AND FOREVER WAIVE ANY AND ALL RIGHTS TO ROYALTIES.
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Step Forward to Prevent Suicide Registration Form