YOUTH CEO ACADEMY 2022 REGISTRATION

Name*

First NameLast Name

SCHOOL*

GRADE*

EMAIL*

STUDENT PHONE NUMBER*

PARENT NAME*

First NameLast Name

PARENT WECHAT*

PARENT PHONE NUMBER*

Parent Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I, the above listed student, desire to join any classes, labs, training, club activities and any private sessions with teachers of Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc), I hereby voluntarily, execute this Waiver under the following terms:

I, release and forever discharge and hold harmless the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participating in the classes or other activities of the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc.

I understand that this waiver discharges the organizations from any liability or claim that I, as a participator, may have against the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation on the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc. I also fully understand that the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc do not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance, in the event of injury, illness, death or property damage.

I, as a participator, understand that I expressly waive any such claim for compensation or liability on the part of the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc beyond what may be offered freely by the representative of the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc in the event of such injury or medical expense.

I grant unto the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc, all right, title, and interest in any and all photographic images and video or audio recordings that are made by the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc during my participation with the Organization, including, but not limited to, any royalties, proceeds, or other benefits that are derived from such photographs or recordings.

I acknowledge that the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc have not arranged and does not carry any insurance of any kind for my benefit. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in Volunteer Activities.

I also understand that this document is a contract which grants certain rights to and eliminates the liability of the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc. I also understand the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc reserves the right of terminating the participation of the student when it is in the best interest of either the student or the whole class.

By agreeing to this waiver, I am also agreeing to the Usarooted International, Inc( DBA: Youth CEO Academy), CEO Hub, Inc's Registration Cancellation, Withdrawal & Refund Policies, available by clicking the Refund Policy button on the www.youthceoacademy.org homepage

Signature*