• Heart of the City Registration & Waiver

  Register for the Be The Proof Foundation Heart of the City program and complete the liability waiver.

• Participant Information

• Participant First Name*
• Participant Last Name*
• Date of Birth*
   -Month -DayYear

  Date
• Age*
• Gender*
  MaleFemale
• Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
• Email Address*
  example@example.com
• Home Address*
  Street Address

  Street Address Line 2

  CityState / ProvincePostal / Zip Code Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country
• City*
• State*
• Zip Code*
• School Name
• Emergency Contact Name*
  First NameLast Name
• Emergency Contact Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.

• Parent/Guardian Information

• Parent/Guardian Full Name*
  First NameLast Name
• Parent/Guardian Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
• Parent/Guardian Email*
  example@example.com
• Parent/Guardian Signature*

• Health & Wellness Questions

• Do you have any medical conditions we should know about?*
• Are there any allergies?*
• Are you currently taking any medication?*
• Do you have any injuries or physical limitations?*
• Anything else we should know to help support your participation?

• Program Interests

• Program Interests*
  CPR & Life Saving SkillsStop the Bleed TrainingSports Therapy & RecoveryFitness & ConditioningPlant-Based NutritionHolistic WellnessMedical Career ExposureCulinary & Performance NutritionLeadership DevelopmentCommunity Wellness Events

• Liability Waiver

• Waiver Acknowledgment
• Participant Signature*
• Parent/Guardian Signature (if under 18)

• Communication Opt-In

• I agree to receive text messages from Be The Proof Foundation about programs, events, schedule updates, and opportunities*
  Yes
• I agree to receive emails from Be The Proof Foundation about programs, community opportunities, wellness initiatives, and updates*
  Yes
• Message and data rates may apply. Participants can opt out at any time.
• Submit RegistrationSubmit Registration
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