Project 61 Youth Application 2018

Youth Registration and Participation Agreement for Caregiver

We're glad you're interested in your youth joining us at the Rose Bowl! Youth programming at the Rose Bowl includes Late Night, Late Night Overnights, Late Night Field Trips, Girls Club, Role Models, and other youth programs!

Late Night at the Rose Bowl is an opportunity for teens (ages 13-18) in middle school and high school to have fun in a safe, relaxed, and supportive environment. The Rose Bowl is open most Friday evenings from 7:00-10:30 PM for teens to play games, eat dinner, build relationships, and try various activities in a safe space with One Hope staff and volunteers.

Girls Club is a support group for middle school-aged girls, 6th - 8th grade, that meets weekly. Girls can expect to build safe relationships with staff/ volunteers and peers and enjoy crafts, games, snacks, and a short group learning and discussion time.

Role Models is a support group for middle school-aged guys, 6th - 8th grade, that meets weekly. Guys can expect to build safe relationships with staff/ volunteers and peers and enjoy games, snacks, various activities, and a short group learning and discussion time.

THIS FORM MUST BE COMPLETED BY A PARENT/GUARDIAN.

YOUTH INFORMATION

Youth's Name *

First Name Last Name

Youth's Birthday *

Date

Youth's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Youth's School *

Is the youth bringing any medication to events? *

YES NO

Please list any medications the youth will be bringing to programs.

Does the teen have any allergies? *

YES NO

Please list any allergies.

Are there any medical or behavior issues we should be aware of? If yes, please explain. *

What are ways we can actively bless your youth while there at our program?

Is there anything else you would like us to know about your youth?

CAREGIVER INFORMATION

Your Name *

First Name Last Name

Your Cell Phone Number *

Area Code Phone Number

Your Email Address

Your Address if different than the youth's.

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

EMERGENCY CONTACT INFORMATION

Who should we contact when we cannot get ahold of the caregiver listed above?

Emergency Contact's Name *

First Name Last Name

Emergency Contact's Phone Number *

Area Code Phone Number

Rose Bowl Policy

These policies are in place to help make sure the Rose Bowl is a safe, fun, and supportive place for all! Please make sure you and your youth understand the following policies.

1.Do you understand this is a weapon and violence free place?
2.Do you understand this is a drug, tobacco, and alcohol free place?
3.Do you understand this is a PDA, sexual activity, sexual harrasment, and pornography-free place?
4.Do you understand this is a put down free place?
5.No fighting of any kind allowed including play fighting.
6.Do you understand that you must find a ride home and sign out to leave?
7. Once you step into Late Night, you must stay until you are ready to leave for good.

I understand and will respect One Hope's Youth Program Policies. I recognize that my youth is expected to know, understand, and comply with these policies while attending or being transported to a One Hope Event.

I UNDERSTAND AND AGREE

LIABILITY & MEDIA RELEASE

I am aware that during participation in activities at the Rose Bowl certain risks and danger may occur. These include, but may not be limited to, the hazards of being in an urban area, the force of nature, and other reasons because of the content of some of the ministries and activities. Springs of Grace/One Hope will take all reasonable precautions to ensure the safety of participants, but injuries, heat stroke, asthma, allergic reactions, etc, can occur in the normal course of games and sports. In consideration of these ministries and activities, I do hereby assume all risks and will hold One Hope and the employees/leadership/staff harmless from any and all liability, actions, cause of action,debts, claims, and demands of every kind and nature whatsoever which I now have or which may arise from or in connection with my participation in any activities arranged for me by One Hope or occurring at the Rose Bowl. The terms hereof shall serve as a RELEASE AND ASSUMPTION OF RISK for my heirs, executors, and administrators, and for all members of my family. In case of accident or illness, One Hope will attempt to provide first aid and arrange transportation to medical services if needed. I give them permission to authorize medical services or transportation as needed. Cost of medical care beyond first aid is the financial responsibility of the ill or injured person. I assume full responsibility for my health being such that the activities will in no way aggravate any conditions present. I declare the statements on this form to be true. I also agree that I will follow One Hope policies. I also release all images, videos, quotes, and other media that includes or features me to be used by One Hope as they see fit.

Are you in agreement? *

Has the youth ever been found guilty or pled guilty or no contest to a criminal charge of any kind? *

YES NO

Has the youth ever had a civil lawsuit alleging actual or attempted sexual abuse or misconduct, child abuse, physical abuse, or financial misconduct brought against him/her? *

YES NO

Has the youth ever had any allegations of actual or attempted sexual abuse or misconduct, child abuse or neglect, financial misconduct, intoxication, or use of illegal drugs made against him/her? *

YES NO

If the answer to any of the previous three questions is yes, please explain here.

TRANSPORTATION INFORMATION

We have a limited ability to provide transportation. If you or your youth would like help navigating how to get to the Rose Bowl using the Tulsa bus routes, we would be happy to ride with you/your youth and show you how to best access the Rose Bowl from your location. Students ride free.

For some programs, transportation home after the program is available within a 2-mile radius of the Rose Bowl.

If you would like to talk to us more about transportation or want help navigating the bus route to the Rose Bowl, please comment here and let us know where you need transportation from.

Does your youth have permission to walk home from the Rose Bowl? *

Yes No

Please list anyone who is NOT permitted to pick-up your youth from the Rose Bowl:

You can also reach out about our youth programs by emailing jordanallison@onehopetulsa.com or by calling/texting our office phone 918-954-4147.

If you have any questions about or suggestions for One Hope's Youth Programs, please comment here.