By submitting this form, I acknowledge and agree that I am voluntarily providing the information requested to the Miami Valley Hospital Foundation, Miami Valley Hospital, Premier Health, and the Promise to Hope Program. I understand and consent that this information may be used by the Miami Valley Hospital Foundation and/or the Promise to Hope Program to contact me for purposes related to my submission, including but not limited to follow-up communications, support, or informational updates. I confirm that I have read and understood this consent and agree to the use of my personal information as described.