Youth and Government - Club Officer Training 2018

Full Name*

First NameLast Name

Please Submit a School photo, or selfie

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School or Club Name*

Current Grade*

6th Grade7th Grade8th Grade

If you are currently in 8th Grade, what High School will you be attending next year?

Student Email Address*

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Birthdate*

Address*

Street Address

Street Address Line 2

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Postal / Zip Code

Parent E-mail*

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Parent 2nd Email

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Emergency Contact Name*

Emergency Contact #*

Area CodePhone Number

T-shirt Size*

Food Allergies or restrictions*

YMCA Youth and Government

Youth Code of Conduct &

Permission Slip Form

I understand and agree that:

1. Mature and responsible behavior is expected from each delegate. Delegates should practice the four core values of the YMCA: caring, honesty, respect and responsibility.

2. No one is permitted to leave the conference grounds. If, for any reason, a delegate should have to leave, he/she must clear this with the conference office and his/her advisor.

3. Use of tobacco or vaping products of any kind are not permitted.

4. Any delegate who violates rules #1-4 shall be dealt with on an individual basis at the discretion of his/her advisor. The State Director shall make the ultimate decision. Possible penalties include, but are not limited to:

· Suspension of free time

· Loss of bill sponsorship

· Loss of speaking privileges

· Loss of delegate privileges and departure from the conference

Hold Harmless Agreement

By my signature, and of my free will, I do hereby agree to indemnify and hold harmless the YMCA of Greater Oklahoma City from any and all claims or demands, costs or expenses arising out of any injuries, damages or other losses, whether personal or property sustained by me or any party to whom I am responsible.

Photo and Video/Audio Recording Release

For my participation in activities conducted by the YMCA of Greater Oklahoma City, I hereby give permission and consent, now and for all time, to the YMCA of Greater Oklahoma City, the National Council of Young Men’s Christian Associations of the United States of America (YMCA of USA) and third parties collaborating with the YMCA of Greater Oklahoma City and/or YMCA of USA to make, reproduce, edit, broadcast or rebroadcast any video film, footage, sound track recordings and photo reproductions of me and/or my dependent. My narrative account of my experience at the YMCA of Greater Oklahoma City may be used for publication, display, sale or compensation to, and/or claim. I may, or may not be, identified in such reproductions; however, I shall not be stated by name to have endorsed a particular commercial product or commercial service.

By signing below, you {fullname}, are agreeing to all of the above areas: Permission for Transport, Authorization for Emergency Medical Care, Hold Harmless Agreement and Photo and Video/Audio Recording Release.*

{emergencyContact11} By signing below, As the Guardian of {fullname}, you are agreeing to all of the above areas: Permission for Transport, Authorization for Emergency Medical Care, Hold Harmless Agreement and Photo and Video/Audio Recording Release.*

Please select how you will be paying the MLD Registration fee

Pay online with a cardMy School is collecting my fee (Please verify with your Teacher)

My Products

Model Legislative Day Registration $20.00

This fee covers fee for registration, Bill Book, and Model Legislative 2022 T-Shirt

Total $0.00

Model Legislative Day Student Registration 2022