Motorcycle Santa Medical Hardship Support Program

Purpose of Consent

As a participant in the Motorcycle Santa Medical Hardship Program, you are invited to share your story, which may include personal, medical, and photographic information. By signing this form, you give Motorcycle Santa permission to collect, use, and share this information for purposes related to community outreach, public awareness, fundraising, and program documentation.

Types of Information Collected and Used

You are consenting to the potential collection and use of the following:

- Personal narratives (written or verbal accounts of your experience)
- Personal details (e.g., name, age, location, gender)
- Medical information relevant to your story or application
- Photographs and video recordings (including likeness and voice)

Purpose of Use

You are consenting to the potential collection and use of the following:

- Sharing stories through websites, social media, brochures, press releases, and newsletters
- Promoting awareness of the Motorcycle Santa Medical Hardship Program
- Fundraising and donor engagement efforts
- Educational or advocacy initiatives

Your information may appear in both print and digital formats, including public-facing materials.

Confidentiality and Use Preferences

Please indicate your preferences by checking the applicable boxes:

Voluntary Participation

Participation is voluntary. You may withdraw your consent at any time by contacting Motorcycle Santa in writing. Withdrawal will not affect your eligibility for assistance or future participation in the program.

Consent Statement

I have read and understood the information above. I voluntarily give my consent to Motorcycle Santa to use my personal story, information, and images as indicated.

If participant is under 18 years of age or unable to provide consent: