AUTHORIZATION FOR MEDICAL CARE - SIGNATURE MANDATORY

I do hereby authorize Big Imaginations LLC Young Entrepreneurs Mentor Program to secure and authorize emergency medical treatment as the child listed on the application might require while under the supervision of the said provider. I also agree to pay all the costs and fees contingent on emergency medical care or treatment for this person as secured or authorized under this consent. I authorize my child to be taken to the nearest medical facilities for care, although my preferred providers are listed above. I do hereby indemnify and hold harmless the physician, hospital, and other persons who act in reliance upon this authorization.  Further, my signature verifies that all Medical Information and Health Report Statements listed above are accurate and complete.

 

Note: Every effort will be made to notify the parents/guardians in case of an emergency. 

EMERGENCY CONTACT(S) AND AUTHORIZED TO PICK UP (MUST PROVIDE COMPLETE INFORMATION FOR AT LEAST ONE CONTACT OTHER THAN PARENTS/GUARDIANS)

I have received a copy of Big Imaginations LLC Young Entrepreneurs Mentor Program OVERVIEW/AGREEMENT FORM containing policies and procedures. I have been given the opportunity to ask questions regarding its content.

I have read over the rules and regulations and agree.

I have read over the pick-up and drop-off policy agreement.

When my child is ill, I understand and agree that she/he may not be accepted or remain in the workshop for that week.

 

ASSUMPTION of the RISK/LIABILITY WAIVER RELATED to COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have in many locations, prohibited the congregation of groups of people. Big Imaginations LLC has put in place preventative measures to reduce the spread of COVID-19: however, the Program cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Program could increase your risk and your child(ren)'s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and may be exposed to or infected by COVID-19 by attending the Program and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Program employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense of any kind, that or my child(ren) may experience or incur in connection with my child(ren)'s attendance at the Program or participation in Program programming ("Claims" On my behalf, and on behalf of my children. I hereby release, covenant not to sue, discharge, or hold harmless the Program its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Program, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in the Program.

Big Imaginations LLC Young Entrepreneurs Mentor Program Prayer Committee offers individual and group prayer to members. Prayer is provided on the following topics: attitudes, behavior, self-esteem coping skills, stress management, peer relationship, anger management separation/loss, and social-emational issues. When possible, the prayer request is kept confidential with the exception of threats to harm his/her self, threats to harm someone else, or if the member reports/there is reason to suspect any form of abuse. When it is in the best interest of the child and/or necessary for support methods to be effective: we will contact the parent to seek additional support for the students. Big Imaginations is not a substitute for psychological counseling, diagnosis, or medication It is the responsibility of the parent(s)/guardian(s) to determine whether additional or different services are necessary and whether to seek them for my child. My consent is good for the duration of the requested services.

MEMBERSHIP CONSENT AND REQUIRED RELEASE INFORMATION - SIGNATURE MANDATORY

I, the parent/guardian of the minor child listed on this application, for ourselves, our heirs, executors, and administrators, hereby release, waive, acquit and forever discharge Big Imaginations LLC Young Entrepreneurs Mentor Program and their representatives, successors, insurers, assigns or any other person or entity associated with any of the above organizations such as staff, directors or volunteers, from all liability, claims, demands, or causes of action for any and all loss, damage, injury or death and any claim or damages resulting from use of facilities owned or controlled by the above organizations, or participation in activities of said organizations either at or away from the Program.

Mentoring Program

I, the parent/guardian of the minor child listed on this application, give permission for my child to participate in Big Imaginations LLC Young Entrepreneurs Mentor Program. I fully understand that the program involves my child spending a minimum of three hours every third saturday of the month on-site at the program with mentors, either staff or volunteers selected from the community.

Surveys and Questionnaires

I, the parent/guardian of the minor child listed on this application, give permission for Big Imaginations LLC to survey my child about his or her experience and behaviors, skills, and attitudes using different types of survey instruments. Survey information and samples are available upon request.

 

Photos/Media/Intellectual Property

I give permission for my child's picture,video's, or any other graphic depiction or likeness, to be used by Big Imaginations LLC, its programs, and its activities. All originally created material, unless otherwise noted, is the intellectual property of the Big Imaginations LLC Young Entrepreneurs Mentor Program. No material may be copied or used without the express written permission of the Big Imaginations LLC Young Entrepreneurs Mentor Program.

Miscellaneous

I understand that Big Imaginations LLC Young Entrepreneurs Mentor Program is not responsible for lost or stolen items.

I give my permission to Big Imaginations LLC Young Entrepreneurs Mentor Program to share information about the minor child listed on this application with Big Imaginations partners for research purposes and/or to evaluate the program's effectiveness. Information that will be disclosed to Big Imagianation LLC may include the information provided on this membership application form, and other information collected by Big Imaginations LLC including data collected via surveys or questionnaires. All information provided to Big Imaginations and its partners will be kept confidential.

MEMBERSHIP CONSENT 

I have read the completed application and this form, agree that membership is governed by the rules of Big Imaginations LLC Young Entrepreneurs Mentor Program, and request that my child be admitted into membership.

 

By signing this document, I certify under penalty of perjury. that all the information on this application is correct to the best of my knowledge and belief, and I acknowledge that such information is subject to verification by Big Imaginations LLC or its representatives.

 

YEMP ACCOUNTS

All money not used will be refunded at the end of the program. If a child has to leave the program we ask that the funds be donated to the organization for basic supplies.

We can reserve space for you prior to your $80.00 contribution towards your childs account, however we ask that you make arrangements to contribute the funds prior to to 2nd or 3rd month of being in the program as your child will need inventory to be sucessful in their business. 

 METHODS OF PAYMENT: Cash, Cash App, Paypal, Credit Cards. Please call us with any questions about placement or registration.                                                         

Payments can be made by scanning the code below and entering the amount of your payment that is due.

There is a $3.00 charge for all credit card payments that must be paid at the time of checkout.

Big Imaginations uc 2022 Youth Entrapreneurs Menter Programs Application 5.27 2022