Our best efforts will be made to accommodate your request, however if you are concerned about having food available that you can eat, we suggest bringing snacks and/or food to supplement your diet.

Approximately one or two weeks before event, VIA EMAIL, you will receive:

• Confirmation of volunteer job
• Itinerary of day or job duties
• Address of event

United Stroke Alliance®, a tax-exempt organization, also known as Retreat & Refresh Stroke Camp®, hosts camps for caretakers and survivors of stroke (the “Camp” or “Camps”), fundraising events for stroke camps and stroke awareness.    

I hereby Authorize United Stroke Alliance (“USA”) to use, publish, and/or otherwise disclose my Individual Identifiable Information, which includes but is not limited to: my name, image and likeness, voice and/or picture (my “Information") as described below. This authorization is voluntary, and no individual has coerced or forced me into agreeing to this authorization.

I understand that USA may benefit, monetarily, non-monetarily, or otherwise, from the use of my Information. I understand that I will not be entitled to any compensation for use of my Information, and I specifically release all claims against USA for the same. I understand that once my Information is received by USA, that it may be subject to use, publication or disclosure. I waive any claims of violations of federal, state, or local laws which are the result of said use, publication or disclosure. 

A. Individual Identifiable Information includes, but is not limited to:

• Pictures, sound recordings, videos or written statements containing my image, likeness or voice;
• Interviews or statements by or about me; and 
    

B. Use and Media, my Information may be used

• For publication in print, digital, or electronic media and in any other forms or forum; and
• For inclusion on the USA or Camp website; and
• For use in other promotional materials including by Camp sponsors and partners.

C. Right to Revoke

I acknowledge that I have the right to revoke this authorization in writing by contacting United Stroke Alliance. Any revocation will be prospective and not retrospective meaning USA will have no obligation to remove or edit out my Information from previously published media. 

By checking the box below, I acknowledge and affirm the statements in this authorization for