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Red.Lined 

EIN:87-1295800

PLEASE DO NOT SUBMIT THIS FORM MORE THAN ONCE.

Do not combine names on a single form. SEPERATE FORMS FOR EACH PARTICIPANT


This program is Limited to 15 TOTAL Participants

Age
Identity
My pronouns are:
Pleace Check ALL that appy

Assumption of Risk Agreement

 

I understand that the subject topics may include topics that are sensitive, including but not limited to: Menstruation, the human body, child birth, venereal topics or complications, sex, intercourse and the effect on the body.  

I use this product at my own risk. Red Lined and it's board members hold no responsibility for usage, misusage or product failure. All products are a gift from the donation community,  individually wrapped items. Internal components are untouched by Red Lined. After the product has been received by the requestor Red Lined assumes no responsibility for the item or user. User should do their due diligence to research the product, locate the manufacturer, educate themselves on proper usage including but not limited to insertion, placement, removal, cleaning, risk, IUD indications and usage duration and storage to name a few. If you have questions you should contact your healthcare provider before requesting the item and certainly before using the items.


Photo Release

I consent to be photographed and recorded by video and/or audio means by Red Lined and grant to Red Lined and their partners the right to use any such photograph or recording for any lawful purpose in furtherance of Red Lined's mission.

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We have received your submission! Our program is limited to 15 participants. We will confirm your spot in the program shortly.

If you are a student under the age of 18, please print and return this document on or before the event:

Red Lined Parent Consent Form 

At this time the program is full. If you would like to be placed on a waiting list, you may email us at donate@redlinedperiod.org

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