1. This donation is being made voluntarily on my own accord without any compensation.
2. The donated body will be transported from the place of death to a GHR facility for the donation process.
3. I hereby agree to the release of all medical records of the Donor to GHR.
4. I understand that the donated body may be used by multiple medical education, training, research, medical device development and pharmaceutical organizations, other tissue banks, or others in the medical/scientific research community domestically and internationally by both for-profit and non-profit organizations which GHR has approved to receive tissue.
5. The processing of the body may involve the removal of organs, fluids, extremities including arms, legs, hands, feet, head, spine and other tissues and parts from the body, without limitation.
6. Preservation of the entire body or part of the body using various methods may be involved.
7. The donated body may be involved in research and scientific advancement and education for forensic training, vehicle/transportation safety & development, military, and law enforcement.
8. GHR may transfer the entire body or parts of the body or tissue to one facility or multiple facilities at GHR’s sole discretion.
9. Due to the nature involved with whole-body donation process through GHR, Donor acknowledges that viewing of the body will not be allowed once the body is accepted for donation.
10. Donor acknowledges that GHR cannot guarantee that tissue will be used for any specific research projects, programs or medical education programs. All uses are at the sole discretion of GHR.
11. During the donation processing the body will be screened for communicable diseases including, but not limited to, HIV 1 & 2 (AIDS), Hepatitis B & C.
12. I understand that GHR is a for-profit company.
13. This donation is being made in accordance with California’s Revised Anatomical Gift Act.
14. Trained medical staff will prepare and process the donated body and GHR will treat the donated body with dignity and respect throughout the donation process.
15. I understand I may revoke my consent with GHR for donation/cremation at any time prior to death as long as the revocation is set forth in writing and provided to GHR in accordance with the notice provisions set forth below.
CREMATION PROCESS
16. The unused portion of the donor’s body is required to be cremated after the donation process is completed. This portion of the body is referred to as the Cremains.
17. If the body is accepted for donation there is no charge for the cremation.
18. GHR offers two (2) options for the cremains: Ashes returned to the family/legal representative or scattered at sea. If return of the remains is requested, Donor understands that the cremains may not be returned for up to one (1) year. I hereby request the following: (Please initial one)
    Return of the remains:
    Remains scattered at sea:
19. Only the unused portions of the donor body will be cremated and returned to the persons designated by Donor or scattered at sea as set forth in this Agreement.
20. Only Cremains of the unused portions of the body that were not used for medical research/science and training/education will be returned to the family in an urn if requested in this Agreement. Cremated tissues used for medical research/science and training/education will NOT be returned and will be cremated in a co-mingled fashion and disposed of by GHR in accordance with federal, state or local law.
21. The cremation process is as follows: The human body burns with the casket, container, or other material in the cremation chamber. Some bone fragments are not combustible at the incineration temperature and, as a result, remain in the cremation chamber. During the cremation, the contents of the chamber may be moved to facilitate incineration. The chamber is composed of ceramic or other material which disintegrates slightly during each cremation, and the product of that disintegration is co-mingled with the cremated remains. Nearly all of the contents of the cremation chamber, consisting of the cremated remains, disintegrated chamber material, and small amounts of residue from previous cremations, are removed together and crushed, pulverized, or ground to facilitate inurnment or scattering. Some residue remains in the cracks and uneven places of the chamber. Periodically, the accumulation of this residue is removed and interred in a dedicated cemetery property or scattered at sea.
22. Any jewelry, dental appliances or dental gold/silver, prostheses, and any other foreign materials may be destroyed during the cremation process and will not be recoverable and will not be returned.
23. Pacemakers, defibrillators and radioactive seed implants (therapeutic radionuclides) pose a serious health and safety hazard during the cremation process and will be removed prior to cremation.
24. Please list a description of implanted device(s):
25. Any unclaimed cremains will be spread at sea if after 60 days after notification to the party listed below the remains are not picked up.
26. GHR reserves the right to decline any potential donated gift at its sole discretion. If a body is rejected GHR will not take possession of the body and no cremation will be provided.
27. If you have any questions, please ask us. By signing this Agreement you represent and agree that you fully understand this Agreement.
GENERAL TERMS
28. This Agreement shall be governed by and construed in accordance with the laws of the State of California, without regard to the conflict of laws or choice of law provisions thereof.
29. This Agreement contains the entire and complete agreement between the parties to it and all prior representations, statements, understandings, and warranties are merged into and superseded by this Agreement.
30. Notwithstanding anything contained in this Agreement to the contrary, nothing in this Agreement, expressed or implied, is intended to confer on any person, other than the parties hereto, any rights, remedies, obligations or liabilities under or by reason of this Agreement, and no person or entity that is not a party to this Agreement shall have any standing as a third-party beneficiary with respect to this Agreement or the services contemplated thereby.
31. In the event that any provision of this Agreement is determined to be illegal or unenforceable, such determination shall not affect the validity or enforceability of the remaining provisions hereof, all of which shall remain in full force and effect.
32. Donor hereby agrees to indemnify, release and hold GHR, its Employees, Clients, Contractors, the Crematory, Funeral home, Funeral home Director, Funeral home staff, their affiliates, agents, officers and assigns harmless from any and all loss, damages, liability or causes of action (including attorney’s fees and expenses of litigation) in connection with the cremation and disposition of the cremated remains of this Donor.
33. Each individual signing this Agreement directly and expressly warrants that he/she has, has been given and has received and accepted authority to sign and execute the documents on behalf of the party for whom it is indicated he/she has signed, and further has been expressly given and received and accepted authority to enter into a binding agreement on behalf of such party with respect to the matters concerned herein and as stated herein.
34. All notices to Donor under this Agreement shall be deemed to have been duly given if mailed by registered or certified mail, or by overnight express, postage prepaid, with confirmation of receipt, addressed to the address listed below.

I hereby affirm that I understand and agree with all statements and disclosures listed above and wish to proceed with this whole-body donation.