Bloom, Breathe & Belong · Ages 12–17

A welcoming place to grow and connect.

This form must be completed by the participant’s parent or legal guardian. Bloom Beginnings (12–14) and Bloom & Becoming (15–17) meet separately for age-appropriate activities and conversations. Aire & Ease will provide the confirmed activity, supervision plan, drop-off/pickup rules, and location before attendance.

Registration, consent & waiver

Please complete every required item.

Parent or legal guardian nameGuardian emailGuardian phoneParticipant’s full nameParticipant’s date of birthParticipant’s ageEmergency contact nameEmergency contact phoneAuthorized pickup person (if different)

Parent or guardian photo and video choicePhoto permission is optional and separate from event participation. If you grant permission, complete the Photo, Video, and Audio Recording Release.Accessibility, allergies, or helpful notes (optional)

Aire & Ease Event Participation Waiver — read the complete agreement

1. Voluntary Participation and Assumption of Risk

I voluntarily choose to attend and/or participate in the event identified above, including all related activities, travel, use of facilities, and interaction with other participants. I understand that participation may involve known and unknown risks, including personal injury, illness, death, property damage, theft, loss, accidents, acts or omissions of other persons, and conditions beyond the Organizer's control. I knowingly and voluntarily accept and assume all such risks, whether foreseeable or unforeseeable, to the fullest extent permitted by law.

2. Release and Waiver of Claims

In choosing to attend or participate, I release, waive, discharge, and covenant not to sue the Organizer and its owners, officers, directors, employees, volunteers, agents, sponsors, vendors, contractors, affiliates, successors, assigns, and the owners or operators of the event location (collectively, the "Released Parties") from any and all claims, demands, causes of action, damages, liabilities, costs, or expenses arising out of or related to my attendance or participation, including claims based on the ordinary negligence of a Released Party, except to the extent such liability cannot lawfully be waived.

3. Damage, Theft, or Loss of Property

I understand and agree that the Released Parties are not responsible or liable for any damage to, theft of, or loss of my personal property, vehicle, equipment, money, valuables, or other belongings, regardless of how the loss occurs.

4. Indemnification and Hold Harmless

To the fullest extent permitted by law, I agree to defend, indemnify, and hold harmless the Released Parties from and against any claims, liabilities, damages, judgments, losses, costs, and reasonable attorneys' fees arising from or related to (a) my attendance or participation; (b) my acts or omissions; (c) my violation of event rules or applicable law; or (d) any claim brought by or on behalf of me, my minor child, my guest, or any person for whom I am responsible. This obligation does not apply to conduct or liability that cannot lawfully be indemnified.

5. Medical Care and Expenses

If I become injured or ill, I authorize the Organizer to obtain emergency assistance or medical care when reasonably believed necessary. I understand that the Organizer is not obligated to provide medical care and that I am solely responsible for all related costs. I represent that I am physically able to participate and will disclose any condition that requires reasonable accommodation or makes participation unsafe. I understand and agree that the Organizer and/or Released Parties shall not assume any liability, responsibility, or control over any illness or injury that may occur through my participation in this event.

6. Rules and Conduct

I agree to follow all event rules, safety instructions, and applicable laws. The Organizer may remove me from the event, without refund, if my conduct is unsafe, disruptive, unlawful, or contrary to event rules.

7. Governing Law; Severability

This Agreement will be governed by the laws of the State of Alabama. Any disputes arising from this Agreement shall be governed by the laws of the State of Alabama. If any provision is found unenforceable, it will be modified only as necessary to make it enforceable, and the remaining provisions will continue in full force and effect.

Acknowledgment

I HAVE READ THIS AGREEMENT, UNDERSTAND ITS TERMS, AND SIGN IT VOLUNTARILY. I UNDERSTAND THAT IN SIGNING I AM AGREEING THAT MY PARTICIPATION IN THIS EVENT IS VOLUNTARY, AND I AGREE TO HOLD HARMLESS AND WAIVE ALL CLAIMS OF LIABILITY AGAINST THE ORGANIZER AND ITS ASSIGNS.

Parent/Guardian Consent (Required for a Minor Participant)

I am the participant's parent or legal guardian, have authority to sign for the participant, consent to the participant's attendance and participation, and agree to this Agreement individually and on the participant's behalf.

Aire & Ease Event Privacy Statement — read the complete agreement

Information and Authorized Purposes

The Organization may collect contact, demographic, service-need, referral, and health- or counseling-related information that you voluntarily provide. You authorize the Organization to use the minimum information reasonably necessary to assess your needs; contact you; locate, arrange, and coordinate counseling or other supportive services; follow up on referrals; operate and improve its programs; document services; meet grant, funding, audit, compliance, and reporting requirements; and conduct other lawful activities directly related to participant support, program administration, and the Organization's charitable mission.

Sharing and Safeguards

Information may be shared, when reasonably necessary, with authorized staff, volunteers, contractors, referral providers, community partners, funders, grant administrators, auditors, and government agencies, or as required by law. Grant and program reports should use aggregated or de-identified information whenever reasonably possible. The Organization will use reasonable safeguards, limit access to authorized persons, and will not sell personally identifiable information.

Your Choices

You may revoke this consent in writing, but revocation will not affect actions already taken in reliance on it. This consent expires when the related referral, program, grant, audit, and record-retention purposes are completed, unless a shorter period is required by law. Information disclosed to an outside organization may be governed by that recipient's privacy practices.

Acknowledgment

I have read and understand this statement. I voluntarily consent to the collection, use, and disclosure of my information as described above.

Parent/Guardian Consent (Required for a Minor Participant)

I am the participant's parent or legal guardian, have authority to sign for the participant, and agree to this consent individually and on the participant's behalf.

Parent or legal guardian electronic signature

By typing your full legal name and submitting, you intend to sign these agreements electronically. The Organizer will retain the signed record, form version, and submission date.

Submitting this form records your registration request, waiver version, and acknowledgments. A place is not guaranteed until Aire & Ease sends confirmation. Do not include diagnoses, treatment records, or other sensitive medical information.

Before the event

Final details come first.

Aire & Ease will send the confirmed date, location, cost if any, accessibility information, what to bring, transportation arrangements if offered, and event-specific safety or participation rules before attendance.

This website waiver covers general community events. A venue, excursion, transportation arrangement, or higher-risk activity may require a separate event-specific consent or waiver. Participation is not confirmed until all required forms are completed.