Mi Casa likes to share stories of our participants to foster hope and inspiration in the community, as well as giving insight into the work we do. Will you give your consent to Mi Casa and its partners to use photographs, video footage, audio recordings, and written testimonials for the purpose of advertising, marketing, or discussing the organization's work?

I understand the activities may have an element of hazard and inherent danger, and I take full responsibility for the actions and physical condition of myself. I hereby release and forever discharge Mi Casa and Mi Casa's officers, directors, and employees of any liability, claim, or damage for any injury or loss I may incur by my participation. In the event of an emergency, I give permission to transport myself to a hospital and to secure medical care. 

Information collected from registration forms, questionnaires, and meetings with staff and partners may be used confidentially to help Mi Casa and its partners to evaluate and coordinate services. I grant permission to Mi Casa and its partners to share data confidentially among each other and with outside evaluators for the purpose of evaluating and coordinating services.

By electronically signing and entering today's date below I am certifying that I am the person who has completed the information on this form, that to the best of my knowledge, the information on this registration form is true, and I am aware of the release of liability, information sharing, and photo, video, and audio release statements above. Should you have a problem or complain regarding Mi Casa's programming or staff, please contact Mi Casa's Chief Operating Officer at (303) 573-1302. 

I agree that by typing my full name in the box below and entering today's date, I am electronically signing this form.