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Peoples Health Marketing Consent
Note: Both forms must be submitted if individual is (or is assumed to be) a Peoples Health member.
Select the type of form:
Is the individual a minor?
Marketing Release and Consent for Minors
TO BE COMPLETED IF THE INDIVIDUAL IS A MINOR: I confirm that I am the parent or legal guardian of the person identified below, who is a minor, and that I have read, understand, and approve of the content of this Release. On behalf of myself and the minor person identified below, and for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, I sign this Release below to indicate my voluntary agreement to its terms and conditions.
Is the individual a minor?
TO BE COMPLETED IF THE INDIVIDUAL IS A MINOR: I confirm that I am the parent or legal guardian of the person identified below, who is a minor, and that I have read, understand, and approve of the content of this Release. On behalf of myself and the minor person identified below, and for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, I sign this Release below to indicate my voluntary agreement to its terms and conditions.