AFTER-SCHOOL ALL-STARS PHILADELPHIA-CAMDEN STUDENT APPLICATION

In consideration of my child/ward being allowed to participate in After-School All-Stars virtual and/or on-site programming or After-School All-Stars events and/or field trips, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

2. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULL RESPONSIBILITY FOR MY CHILD’S PARTICIPATION; and

3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation.  If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the virtual or on-site program or related events and activities itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; and

4. After-School All-Stars may provide, or third parties may provide, links or other access to other sites and resources on the Internet. After-School All Stars has no control over such sites and resources and After-School All Stars is not responsible or liable such sites and resources and does not implicitly or explicitly endorse such sites or resources. After-School All-Stars will not be responsible or liable, directly or indirectly, for any damage or loss caused by or in connection with use of or reliance on any content, events, goods or services available on or through any such site or resource; and

5. Should it be necessary for my child to have medical treatment while participating in virtual and/or on-site programming or After-School All-Stars events and/or field trips, I hereby give the After-School All-Stars personnel permission to use their judgment in obtaining personnel to render medical treatment deemed necessary and appropriate by a physician. I agree to relieve the After-School All-Stars and other participating adults from any liability in connection with this request; and

6. I, for myself and on behalf of my heirs, successors, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS AFTER-SCHOOL ALL-STARS, their successors, assigns, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners, and lessors of  premises used for the activity (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property,  WHETHER ARISING FROM THE NEGLIGENCE (ACTIVE OR PASSIVE) OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and

7. I am of full legal age and have read and have freely signed this Minor Liability Release and am fully familiar with its contents. By my signature below, I indicate, on behalf of my minor child, my full and unqualified consent to the terms of this Minor Liability Release.

In consideration of my child/ward being allowed to participate in After-School All-Stars virtual and/or on-site programming or After-School All-Stars events and/or field trips, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and

2. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULL RESPONSIBILITY FOR MY CHILD’S PARTICIPATION; and

3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation.  If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the virtual or on-site program or related events and activities itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; and

4. After-School All-Stars may provide, or third parties may provide, links or other access to other sites and resources on the Internet. After-School All Stars has no control over such sites and resources and After-School All Stars is not responsible or liable such sites and resources and does not implicitly or explicitly endorse such sites or resources. After-School All-Stars will not be responsible or liable, directly or indirectly, for any damage or loss caused by or in connection with use of or reliance on any content, events, goods or services available on or through any such site or resource; and

5. Should it be necessary for my child to have medical treatment while participating in virtual and/or on-site programming or After-School All-Stars events and/or field trips, I hereby give the After-School All-Stars personnel permission to use their judgment in obtaining personnel to render medical treatment deemed necessary and appropriate by a physician. I agree to relieve the After-School All-Stars and other participating adults from any liability in connection with this request; and

6. I, for myself and on behalf of my heirs, successors, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS AFTER-SCHOOL ALL-STARS, their successors, assigns, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners, and lessors of  premises used for the activity (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property,  WHETHER ARISING FROM THE NEGLIGENCE (ACTIVE OR PASSIVE) OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and

7. I am of full legal age and have read and have freely signed this Minor Liability Release and am fully familiar with its contents. By my signature below, I indicate, on behalf of my minor child, my full and unqualified consent to the terms of this Minor Liability Release.

I am a parent/guardian of “My Child” and hereby grant full permission and all rights to After-School All-Stars and their agents to use, adapt, edit, reproduce, distribute, or display My Child’s 

• Name
• Photograph or Video
• Voice
• Face
• Likeness
• Background information
• Works produced by my child (e.g., artwork)

obtained through photographic, video, digital, or other recording forms (e.g., virtual communication or conferencing platforms) from My Child during virtual and/or on-site programming or After-School All-Stars events and/or field trips. I understand the above may be used for video, publications, promotional materials, motion pictures, recordings and all other records or events (present and future forms of media) in perpetuity. I also grant After-School All-Stars, without reservation or limitation, the right to reproduce, copy, exhibit, publish, or distribute any such video recording, or digital file of this footage. To the extent the image or media of My Child is an educational record and may contain personally identifiable information about My Child as defined by the Family Educational Rights and Privacy Act of 1974 (“FERPA”), I hereby consent to the release of the image or media.

I waive any right to inspect or to approve any present and future forms of media that may be created using the above and waive any claim with respect to the eventual use to which the above may be applied. I understand I will not be compensated for use of the above, time spent in making the above, or have any right to any future royalties from or related to the use of the above. My Child was a voluntary participant and agreed to appear in the production without a fee, salary, payment, remuneration or other compensation for the appearance now or in the future.

I waive, release, and discharge any and all rights, claims, demands, and causes of action that I, My Child, or any third party, have or may have against After-School All-Stars and/or any of its agents, affiliates, subsidiaries, successors, or assigns now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation, or any other cause of action arising out of this Media Release or the use, reproduction, adaptation, distribution, publication, broadcast, or display of the above. My release and waiver includes any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of the above, including publication on the internet, in brochures, on posters, or any other advertisements or promotional materials. I understand that After-School All-Stars and/or any of its agents, affiliates, subsidiaries, successors, or assigns shall not be responsible for any use of the image by any third party accessing the image through the internet or any other manner. I further agree to indemnify and hold harmless After-School All-Starts and/or any of its agents, affiliates, subsidiaries, successors, or assigns from any and all rights, claims, demands, and causes of action, as described above.  

I understand that I have the right not to consent to My Child being videotaped, photographed, or recorded during virtual or on-site program and/or After-School All-Stars events and/or field trips, and the right not to consent to the release or use of the image or media and any personally identifiable information about My Child contained in the media, and that this consent shall remain in effect until revoked by me in writing and delivered to After-School All-Stars, though any such revocation shall not affect disclosures previously made prior to its receipt.

I have read and fully understand the above and certify and represent that as a parent/guardian for the above participant, all information I provide on this Media Release is accurate. I am of full legal age and have read this Media Release and am fully familiar with its contents. By my signature below, I indicate, on behalf of my minor child, my full and unqualified consent to the terms of this Media Release.

I am a parent/guardian of “My Child” and hereby grant full permission and all rights to After-School All-Stars and their agents to use, adapt, edit, reproduce, distribute, or display My Child’s 

• Name
• Photograph or Video
• Voice
• Face
• Likeness
• Background information
• Works produced by my child (e.g., artwork)

obtained through photographic, video, digital, or other recording forms (e.g., virtual communication or conferencing platforms) from My Child during virtual and/or on-site programming or After-School All-Stars events and/or field trips. I understand the above may be used for video, publications, promotional materials, motion pictures, recordings and all other records or events (present and future forms of media) in perpetuity. I also grant After-School All-Stars, without reservation or limitation, the right to reproduce, copy, exhibit, publish, or distribute any such video recording, or digital file of this footage. To the extent the image or media of My Child is an educational record and may contain personally identifiable information about My Child as defined by the Family Educational Rights and Privacy Act of 1974 (“FERPA”), I hereby consent to the release of the image or media.

I waive any right to inspect or to approve any present and future forms of media that may be created using the above and waive any claim with respect to the eventual use to which the above may be applied. I understand I will not be compensated for use of the above, time spent in making the above, or have any right to any future royalties from or related to the use of the above. My Child was a voluntary participant and agreed to appear in the production without a fee, salary, payment, remuneration or other compensation for the appearance now or in the future.

I waive, release, and discharge any and all rights, claims, demands, and causes of action that I, My Child, or any third party, have or may have against After-School All-Stars and/or any of its agents, affiliates, subsidiaries, successors, or assigns now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation, or any other cause of action arising out of this Media Release or the use, reproduction, adaptation, distribution, publication, broadcast, or display of the above. My release and waiver includes any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of the above, including publication on the internet, in brochures, on posters, or any other advertisements or promotional materials. I understand that After-School All-Stars and/or any of its agents, affiliates, subsidiaries, successors, or assigns shall not be responsible for any use of the image by any third party accessing the image through the internet or any other manner. I further agree to indemnify and hold harmless After-School All-Starts and/or any of its agents, affiliates, subsidiaries, successors, or assigns from any and all rights, claims, demands, and causes of action, as described above.  

I understand that I have the right not to consent to My Child being videotaped, photographed, or recorded during virtual or on-site program and/or After-School All-Stars events and/or field trips, and the right not to consent to the release or use of the image or media and any personally identifiable information about My Child contained in the media, and that this consent shall remain in effect until revoked by me in writing and delivered to After-School All-Stars, though any such revocation shall not affect disclosures previously made prior to its receipt.

I have read and fully understand the above and certify and represent that as a parent/guardian for the above participant, all information I provide on this Media Release is accurate. I am of full legal age and have read this Media Release and am fully familiar with its contents. By my signature below, I indicate, on behalf of my minor child, my full and unqualified consent to the terms of this Media Release.

• ASAS students should be dressed appropriately. It is encouraged that they dress as if they were attending school.
• ASAS students must respect the learning environment. ASAS students should use respectful language at all times (both spoken and written). Profanity, hate speech, derogatory remarks, name-calling, and other such behavior will not be tolerated. ASAS students should not post anything that could hurt others or have a negative effect such as images, someone else’s social media postings, or inappropriate chat messages.
• Cyber-bullying (e.g., name-calling, sending mean, intimidating, or threatening messages via chat or text, sending anonymous messages) is not acceptable and will not be tolerated. Students who are perpetrators of bullying behavior will be asked to leave the day’s class or may be suspended from the ASAS program.
• ASAS students should not give out personal information (e.g., address, cell phone number, email address, full name) to anyone online while in ASAS virtual programming.
• ASAS students should never arrange to meet in person with ASAS staff or any other adult interacting with them during their virtual learning classes/activities.
• ASAS students should protect their virtual learning passwords such as Zoom or Google Classroom. They should not give them to anyone outside of parents/guardians.
• ASAS students should develop good digital citizenship skills when being online. They should be careful about opening ads or e-mail from unfamiliar addresses.
• ASAS encourages students to join virtual classes with video; if uncomfortable with sharing video, please reach out to programs staff prior to class to confirm your identity.
• Students may eat on camera as long as it does not distract from the virtual learning.
• Students must respect others’ voices when others are sharing/talking.
• Students should feel free to move around and utilize flexible seating during class as long as it is not distracting to others and students feel they are able to focus.
• Students must not take screenshots, pictures, or recordings of virtual classes.

Rules and Agreements for student behavior apply to our virtual learning environments. Behavior problems are recorded in writing and plans for corrective action are noted. Parents are notified if an inappropriate behavior persists.

• If a child continually misbehaves, ASAS staff may separate the child from the program.
• If a child acts in a way that creates a risk of harm and/or health to themselves and anyone else, ASAS may immediately separate the child from the program. 

I have read the above Student Code of Conduct and am aware of the conduct required of my child as an ASAS participant. I also understand that youth actively involved with any negative or harmful actions and/or behaviors listed above are subject to suspension or dismissal from the ASAS program. 

• ASAS students should be dressed appropriately. It is encouraged that they dress as if they were attending school.
• ASAS students must respect the learning environment. ASAS students should use respectful language at all times (both spoken and written). Profanity, hate speech, derogatory remarks, name-calling, and other such behavior will not be tolerated. ASAS students should not post anything that could hurt others or have a negative effect such as images, someone else’s social media postings, or inappropriate chat messages.
• Cyber-bullying (e.g., name-calling, sending mean, intimidating, or threatening messages via chat or text, sending anonymous messages) is not acceptable and will not be tolerated. Students who are perpetrators of bullying behavior will be asked to leave the day’s class or may be suspended from the ASAS program.
• ASAS students should not give out personal information (e.g., address, cell phone number, email address, full name) to anyone online while in ASAS virtual programming.
• ASAS students should never arrange to meet in person with ASAS staff or any other adult interacting with them during their virtual learning classes/activities.
• ASAS students should protect their virtual learning passwords such as Zoom or Google Classroom. They should not give them to anyone outside of parents/guardians.
• ASAS students should develop good digital citizenship skills when being online. They should be careful about opening ads or e-mail from unfamiliar addresses.
• ASAS encourages students to join virtual classes with video; if uncomfortable with sharing video, please reach out to programs staff prior to class to confirm your identity.
• Students may eat on camera as long as it does not distract from the virtual learning.
• Students must respect others’ voices when others are sharing/talking.
• Students should feel free to move around and utilize flexible seating during class as long as it is not distracting to others and students feel they are able to focus.
• Students must not take screenshots, pictures, or recordings of virtual classes.

Rules and Agreements for student behavior apply to our virtual learning environments. Behavior problems are recorded in writing and plans for corrective action are noted. Parents are notified if an inappropriate behavior persists.

• If a child continually misbehaves, ASAS staff may separate the child from the program.
• If a child acts in a way that creates a risk of harm and/or health to themselves and anyone else, ASAS may immediately separate the child from the program. 

I have read the above Student Code of Conduct and am aware of the conduct required of my child as an ASAS participant. I also understand that youth actively involved with any negative or harmful actions and/or behaviors listed above are subject to suspension or dismissal from the ASAS program.