Student Services by Community Education Building Participation Agreement, Including Permissions for CEB Student Advocacy System, Assumption of Risk, Waiver and Indemnification

This form, which must be completed for each participant enrolled in the CEB's Student Services Programs, including Student Advocacy ("Participant"), explains certain policies and procedures, and grants certain permissions and consents relevant to your child's participation in Student Advocacy (the "Program" It also contains an assumption of risk, release of liability, and indemnification agreement related to certain activities your child may be participating in during the Program. Please read and review this form carefully with your child and sign it. Participants who are 18 and over must sign as well, as the "Assumption of the Risk, Release of Liability and Indemnification Agreement" section will apply to them; however, the Participant's parent's signature is required regardless of the age of the Participant.

PARTICIPATION POLICIES AND PROCEDURES

The purpose of CEB's Student Support Services is to provide students with academic enrichment, 1:1 mentoring, life skills, social-emotional support, interest-based enrichment, and engagement both during and after traditional school hours. Participants agree to undertake the work the program requires, as well as to actively participate in guide sessions.

If a participant is displaying any signs or symptoms of COVID-19, is running a temperature, or cannot taste or smell, that participant may not attend the program until they produce a negative COVID test. If a participant is otherwise ill, they may not attend the program but may return once they are feeling better.

All participants with medical allergies or conditions must disclose the same to the CEB and the assigned learning guide, with specific details. participants with medical allergies or conditions shall be required to bring their medication with them to the location daily. If a participant arrives without their medication, the parent or guardian will be contacted and notified.

If a participant becomes disruptive during programming, the parent or guardian will be contacted. If the participant continues to be disruptive of others' learning, they may be asked to leave for the day. If behavior is repeated, your child may be asked to leave the program.

I acknowledge that my child is in good mental and physical condition for the limited purpose of program registration and participation. By signing below, I acknowledge that I have read and agree to this policy.

Permissions: By signing this document, I acknowledge that the Program is being offered in person. I grant permission to provide emergency care for my child, if needed. I grant blanket permission for my child to participate in any of the activities listed below (collectively, the "Activities") during the Program:

1. Group conversations 2. Credit recovery and any online academic work 3. Group sessions with Student Advocates 4. Interactive learning sessions with all CEB and partner organizations 5. Enrichment, Academic, and Engagement activities 6. Social-Emotional Learning support, 6. Life skills sessions, 7. 1:1 mentorship sessions, 8. The Born 4 Brothers student support program, 9. Rise to Thrive student advocacy, 10. Project-based learning, 11. Local enrichment field trips. 

Consent to Recording and Photographs: I hereby authorize the Program to photograph and/or video/audio record ("Record") my child during the Program, and use or distribute any photograph, audio or video recording ("Materials") related to the Program activities that my child is depicted in. I also authorize use of these Materials for publication in a brochure, on Program websites, or other Program promotional material. The Program may use my children's name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such Materials. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph. Materials may also be distributed to other Program participants, or the public, for educational purposes, including but not limited to a group photograph of all participants.

Consent to Share Personal Information for Program Purposes: Additionally, by signing below, you agree to allow the Program to acquire from the school the following personally identifiable and academic information: full name and email address of your child, academic grade reports, individual education plans, current grades, and progress reports, disciplinary records, for the purpose of your child’s participation in the CEB student services programs. You may withdraw your consent to share this information at any time. A request to withdraw your consent should be submitted in writing and signed.

ASSUMPTION OF RISK, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT

Assumption of Risk: By signing this document, I hereby acknowledge that my child's participation in the Activities involve risks, both foreseeable and unforeseeable, known and unknown, associated with CEB Student Support Services, and risks caused by the actions, inactions, and/or negligence of others, including Program employees, agents, volunteers and students, that could result in my child sustaining property damage, or emotional or physical injury ("Risks"), and I knowingly and voluntarily assume these Risks as they might affect myself or my child.

Release of Liability and Indemnification: By signing this document, in consideration of my child being able to participate in the Activities, and on behalf of myself, my child, my legal representatives, heirs, executors, conservators, successors and assigns, I hereby release, acquit, discharge, covenant not to sue and hold harmless the Program, the Community Education Building LLC, PS#5 LLC and all affiliated organizations, each of their affiliated entities, trustees, directors, officers, employees, agents, volunteers and/or students (hereinafter referred to as "Releasees") from and against any and all liabilities, losses, claims, suits, causes of action, demands, judgments, costs and expenses (including attorneys' fees and court costs) of any kind or nature, including without limitation property damage, personal injury and death, arising out of or in any way connected with my child's participation in the Activities, regardless of whether caused, or contributed to, by the acts, omissions and/or ordinary negligence of any or all of the Releasees. I also agree to defend, hold harmless and indemnify the Releasees from and against any and all

liabilities, losses, claims, suits, causes of action, demands, judgments, costs and expenses (including attorneys' fees and court costs) of any kind or nature, brought by me or my child, or on behalf of me or my child, or any third party against the Releasees arising out of or in connection with my child's participation in the Activities, regardless of whether caused, or contributed to, by the acts, omissions and/or ordinary negligence of any or all of the Releasees.

I warrant that I am fully able to enter into this release and that this release also applies to my child(ren), my heirs, assigns, personal representatives, and estate.

Choice of Law; Modifications: I hereby agree that this Participation Agreement shall be interpreted under, and construed in accordance with, the laws of the State of Delaware, and shall not be amended or altered except in a writing signed by me and the Program.

AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND CONTRACT BETWEEN MYSELF AND THE PROGRAM AND SIGN OF MY OWN FREE WILL.