2025 Hearts For Heroes Registration

The cost for this event is being provided by the ASYMCA of Hampton Roads. Although the event is free of charge, there are limited registrations available.

Please note, we request that all cancellations be made by contacting Sabrina Murphy at SMurphy@asymca.org or 757-363-1884 on or before May 26, 2025

I understand that the Armed Services YMCA of Hampton Roads is not responsible for personal property lost, damaged, or stolen while using the ASYMCA facilities on the ASYMCA premises, or involved in ASYMCA programs.

I give the Armed Services YMCA (“ASYMCA”) and its employees and agents permission to use my likeness, voice and/or appearance as such may be embodied in any pictures, drawings, renderings, photographs, video recordings, audiotapes, or digital images for the purpose of promoting ASYMCA’s programs, services, and mission with the understanding that the ASYMCA will not publish my protected or confidential information. I agree that the ASYMCA has complete ownership of such pictures, etc., including but not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including but not limited to the internet, television, radio, newspapers, magazines, social media sites (e.g., Facebook, Twitter, Instagram, Flickr, blogs, etc.), and/or ASYMCA audio, print, or internet publications. I also agree that the ASYMCA has permission to release such pictures, etc. to the news media. I acknowledge that I will not receive any compensation or remuneration for the use of such pictures, etc. I understand that once such pictures, etc. are published to the media, on the internet, or are otherwise published to any medium, they may be used in publications and/or on websites outside of ASYMCA’s control.

I am an adult over 18 years of age and wish to participate in, or have my child/children participate in Armed Services YMCA of Hampton Roads program activities. IN CONSIDERATION of being permitted to utilize the facilities, services, and programs of the ASYMCA, including but not limited to observation or use of the facilities or equipment, or participation in any off-site affiliate with ASYMCA, the undersigned, for himself or herself and any personal representatives, heir, and next of kin, hereby acknowledges, agrees and represents that he or she has immediately upon entering or participating inspected and carefully considered such premises and facilities or the affiliated program. In addition, I give my child/children permission to participate in the Armed Services YMCA of Hampton Roads programs. I understand that even when every reasonable precaution is taken, accidents can sometimes happen. Therefore, in exchange for allowing my child/children to participate in ASYMCA activities, I understand and expressly acknowledge that I, for myself, or anyone entitled to act on my behalf waive and release the ASYMCA, sponsors, representatives, and successors from all claims or liabilities of any kind arising out of my participation in activities at or sponsored by the YMCA. I further agree to indemnify and save harmless the ASYMCA from any claims or demands arising from such injuries or loses. I understand that this release includes any claims based on negligence, action, or inaction of the Armed Services YMCA of Hampton Roads, its staff, directors, members, and guests. I have read, understand and am voluntarily signing this authorization and release.

I certify that the above information is true and can provide documentation of my injury while serving in the line of duty.

The cost for this event is being provided by the ASYMCA of Hampton Roads. Although the event is free of charge, there are limited registrations available.

Please note, we request that all cancellations be made by contacting Sabrina Murphy at SMurphy@asymca.org or 757-363-1884 on or before May 26, 2025

I understand that the Armed Services YMCA of Hampton Roads is not responsible for personal property lost, damaged, or stolen while using the ASYMCA facilities on the ASYMCA premises, or involved in ASYMCA programs.

I give the Armed Services YMCA (“ASYMCA”) and its employees and agents permission to use my likeness, voice and/or appearance as such may be embodied in any pictures, drawings, renderings, photographs, video recordings, audiotapes, or digital images for the purpose of promoting ASYMCA’s programs, services, and mission with the understanding that the ASYMCA will not publish my protected or confidential information. I agree that the ASYMCA has complete ownership of such pictures, etc., including but not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including but not limited to the internet, television, radio, newspapers, magazines, social media sites (e.g., Facebook, Twitter, Instagram, Flickr, blogs, etc.), and/or ASYMCA audio, print, or internet publications. I also agree that the ASYMCA has permission to release such pictures, etc. to the news media. I acknowledge that I will not receive any compensation or remuneration for the use of such pictures, etc. I understand that once such pictures, etc. are published to the media, on the internet, or are otherwise published to any medium, they may be used in publications and/or on websites outside of ASYMCA’s control.

I am an adult over 18 years of age and wish to participate in, or have my child/children participate in Armed Services YMCA of Hampton Roads program activities. IN CONSIDERATION of being permitted to utilize the facilities, services, and programs of the ASYMCA, including but not limited to observation or use of the facilities or equipment, or participation in any off-site affiliate with ASYMCA, the undersigned, for himself or herself and any personal representatives, heir, and next of kin, hereby acknowledges, agrees and represents that he or she has immediately upon entering or participating inspected and carefully considered such premises and facilities or the affiliated program. In addition, I give my child/children permission to participate in the Armed Services YMCA of Hampton Roads programs. I understand that even when every reasonable precaution is taken, accidents can sometimes happen. Therefore, in exchange for allowing my child/children to participate in ASYMCA activities, I understand and expressly acknowledge that I, for myself, or anyone entitled to act on my behalf waive and release the ASYMCA, sponsors, representatives, and successors from all claims or liabilities of any kind arising out of my participation in activities at or sponsored by the YMCA. I further agree to indemnify and save harmless the ASYMCA from any claims or demands arising from such injuries or loses. I understand that this release includes any claims based on negligence, action, or inaction of the Armed Services YMCA of Hampton Roads, its staff, directors, members, and guests. I have read, understand and am voluntarily signing this authorization and release.

I certify that the above information is true and can provide documentation of my injury while serving in the line of duty.