Cub Club Consent

Thank you for adding your cub to the club! Your consent establishes the following:

As the parent or legal guardian of (the “Child”), I hereby grant Overlake Medical Center Foundation (the “Foundation”) permission to publish the following personal information (the “Information”) about the Child on the Foundation’s public website in connection with the Polar Bear Cub Club (overlakehospital.org/cubclub) (the “Website”):

• First name
• Last initial
• Birth year

Purpose of Publication: The Information will be published on the Foundation’s Website in association with acknowledging one (1) or more donations made by family or friends of the Child to the Foundation in celebration of the Child’s birth. 

Duration of Publication: The Foundation is authorized to publish the Information of the Child on the Website for the duration of the Website's existence.

Voluntary Participation: I understand that my authorization is voluntary and that I may refuse to agree to this consent. I also understand that I can withdraw my consent at any time by providing written notice to the Foundation via email: foundation@overlakehospital.org or mail: 1035 116^th Ave. NE Bellevue, WA 98004.

Right to Privacy: I fully understand and acknowledge that I am expressly consenting to the public disclosure of the Child's personal information as specified above. I acknowledge and agree that by consenting, I am relinquishing the Child’s privacy rights with respect to the disclosed information as specified above.