Waiver and Release

I, the undersigned parent/guardian, hereby express my desire and approval for the participation of my child, as a member of Youth Connect Club Inc., (hereafter referred to as Youth Connect Club), and acknowledge that such participation may include, without limitation, travel, participation in physical activities and the use of equipment and supplies as applicable. I further acknowledge that participation in the program is entirely at my risk and the risk of my child. I hereby promise not to bring a claim against or sue, and AGREE TO RELEASE Youth Connect Club, its sites, employees, affiliates, agents, landowners, officers, directors, and their successors in interest, any equipment manufacturers and distributors, together with each of their officers and managers, (collectively “PROVIDERS”), from all liability for injury, illness, death, and property loss and damage that results from participation in Youth Connect Club activities. 

 

Medical

I authorize PROVIDERS to administer first aid as they deem necessary. I authorize transportation to a medical facility, at my expense, if deemed necessary by PROVIDERS. Further, in the case of serious illness or injury, if I cannot be reached, I give permission for treatment, including medical and/or surgical care necessary for the well-being of my child, at my expense. I agree that upon transporting the child to any medical facility, clinic or hospital that the responsibility of the PROVIDERS shall be totally fulfilled and the PROVIDERS shall have no further responsibility for the child. I UNDERSTAND THAT YOUTH CONNECT CLUB WILL, TO THE BEST OF ITS ABILITY, ATTEMPT TO NOTIFY ME AS SOON AS POSSIBLE IN THE EVENT OF AN EMERGENCY. 

 

Photo Release

I hereby grant exclusive permission to Youth Connect Club and their respective agents, clients and assigns to use my Child/Children’s name and image(s) as well as parents/guardians for the purpose of publicity, public relations, editorial, or other advertising purposes without restriction as to frequency or duration. 

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Participation

I acknowledge that it is the responsibility of my child to choose the applicable programs they wish to participate in. It is their responsibility to inform a staff member if they do not wish to participate in an activity. 

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Personal Property

I understand that Youth Connect Club is not responsible for lost or stolen articles. I acknowledge that my child must follow the rules and guidelines of Youth Connect Club. In the event of any disciplinary issues I will be contacted and appropriate action will be taken by the staff up to and including suspension from Youth Connect Club. 

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Open Door Policy

I acknowledge that Youth Connect Club maintains an Open Door Policy. Members are welcomed and supervised in the facility under safety and citizenship guidelines. Staff does not grant permission for children to leave Youth Connect Club, nor do they insist that members stay. The decision as to when a child arrives at Youth Connect Club and with whom he/she leaves is a matter arranged between parent and child. 

 

Information Usage

I give my permission to Youth Connect Club to share information about the minor child listed on this application with Youth Connect Club associates for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to these associates may include the information provided on this membership application form, information provided by the minor child’s school or school district, and other information collected by Youth Connect Club, including data collected via surveys or questionnaires. All information provided to Youth Connect Club will be kept confidential. 

 

Transportation and Extended Stay

I grant permission for my child to participate in field trips and fundraising activities at Youth Connect Club. Transportation will be walking or provided by a Youth Connect Club vehicle as applicable. I understand that there might be times that I will be asked to provide transportation for my child. I understand that some field trips may require an additional release form and/or additional fees. I understand that Field Trips and activities may involve staying overnight either at Youth Connect Club facility, or with an approved mentor at a location off-site in the event of camping trips, lock-ins and sleepovers. It is my responsibility to let my child know if he/she can or cannot participate in these activities and field trips, and it will be his/her responsibility to notify staff of this. 

 

Internet

I grant permission for my child to participate in the Computer Lab programs, including use of the Internet. I understand that my child will be required to follow all guidelines regarding the use of the internet. Bringing cell phones and other electronic devices to Youth Connect Club are discouraged, and the device may be taken away if a member abuses its use. 

As parent/guardian of the below-named minor(s), I acknowledge that I am authorized to sign this agreement for the minor. I acknowledge and agree that I have read the foregoing release and that by signing this release on behalf of the minor, the minor and I agree to be bound by its terms. I hereby agree to INDEMNIFY, DEFEND AND HOLD HARMLESS PROVIDERS as defined on this form, for any claim, suit, expense or loss which arises out of the below-named minors participation in Youth Connect Club, its programs, activities, or events.