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North Dakota T-shirt Consent Form
North Dakota Heart Warrior T-Shirt Consent Form
First name
Last name
Email
Phone
Address
North Dakota Heart Warrior Name and Heart Condition
Mark all that apply
Yes. The name submitted has been on previous T-shirts before.
No. The name submitted has not been on previous T-shirts before
The name submitted is from or has ties to North Dakota
You are the legal guardian of the name submitted (If the name submitted is under the age of 18)
You may not be from North Dakota, but you're interested in organizing a separate t-shirt campaign.
The name submitted has a CHD
Do you consent to the use of your or your child's name on the apparel?
Date
Month
Day
Year
Do you confirm that everything you have stated is accurate and that you have double-checked the spelling?
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
I consent to receive email communications, including marketing updates, from Brave Hearts Children's Network Inc.
Yes
No
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