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Participant Release & Consent Form
Participant Release v1.0 — July 2026
Step 1 of 4
Your information
Full legal name *
Preferred public/professional name
Pronouns (optional)
Date of birth *
Email *
Phone *
Mailing address
City
State
ZIP
Occupation / trade / role *
Business/organization
Business website
Social handle (optional)
Edition(s) this release applies to *
Traditional Dirty Job
Heart Edition — emotionally demanding or caregiving work
Business Owner or Entrepreneur
Public Service or First Responder
Healthcare
Hospitality or Service Industry
Skilled Trade
Other
Age *
I am 18 or older
I am under 18 (parent/guardian required)
Emergency contact name
Phone
Relationship
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