WAIVER AND RELEASE OF LIABILITY:  I, the parent/guardian of the above-named student (or the undersigned student over the age of 18) waive, release and agree to hold harmless the Capital Region Community Foundation (CRCF) and their respective agents, officers, board members, representatives, employees, YAC advisors, YAC coordinators and volunteers (the “Releasees”) from any liability to the undersigned and the personal representatives, heirs, assigns, and family of the undersigned, for all loss or damages on account of injury to the person or property of the above named student relating to participation in the YAC or transportation to or from YAC activities. The undersigned have read the Waiver and Release and voluntarily sign.

AUTHORIZATION FOR MEDICAL TREATMENT:  I, the parent/guardian of the above-named student, (or the undersigned student over the age of 18) realize that situations arise that require medical services and treatment be provided to my child in my absence or unavailability. I also understand that circumstances may not always permit referral to the information contained in this permission and release form prior to the rendering of treatment and medical services.  Therefore, in my absence or unavailability I hereby give permission to authorized medical or Capital Region Community Foundation personnel to treat and provide medical services to the child identified above which said persons believes to be medically necessary.  I hereby release the Capital Region Community Foundation from liability for these medical services and treatment without regard to any notice which may be obtained in this permission form.  Medical services and treatment include but are not limited to transfer of my child by ambulance or other means to a hospital or clinic and referral to a physician as deemed appropriate by the above authorized personnel.  Further, I assume responsibility for all financial obligations for these medical services and treatment.

MEDIA RELEASE: I, the parent/guardian of the above-named student (or the undersigned student over the age of 18) give my permission to Capital Region Community Foundation to use my child’s name, photograph, video, the use of statements made by or attributed to my child, or any likeness for publicity or similar promotion, and grant the Foundation any and all rights to said use without further compensation. I understand that my signature below releases the Foundation from any financial or legal responsibility for the use of media relations/promotional materials.

CONSENT FOR TRANSPORTATION: YAC members are responsible for their own transportatoin to and from any in-person activities. However occasionally it is necessary for a Foundation staff member or YAC advisor to transport a YAC member. (Please Note: YAC Advisors have passed a criminal background check and have signed the Foundation’s Working with Youth and Vehicle Use policies.)

I, the parent/guardian of the above-named student (or the undersigned student over the age of 18) give my permission to Capital Region Community Foundation Youth Advisory Council advisor(s) to provide transportation for my child for YAC activities, in the event this becomes necessary.

PERMISSION TO PARTICIPATE:  I hereby give my permission for the above-named student (or undersigned student over the age of 18) to participate in the Youth Advisory Council of the Capital Region Community Foundation as described above and I further agree to all the terms of the Waiver and Release of Liability stated herein.