Please read the following. Every section must be agreed upon in order to participate in this program.
I hereby authorize YMCA of the East Bay and its authorized director and/or leaders (collectively the YMCA) or an authorized representative of the Y&G program in conjunction with the local YMCA to act as guardians for the above named individual. The guardianship grants authority to consent to any medical, dental, surgical or mental health diagnosis or treatments, and hospital care to be rendered to the individual under general or special supervision and upon advice of a health care provider licensed under the laws of the state or any other jurisdiction in which emergency medical care is sought. For the purpose of medical care or dental care obtained in the State of California, this authorization is given pursuant to the provisions of section 25.8 of the California Family Code, as amended. I have read and agree to these conditions.
For parents or guardians with participants under 18, all efforts will be made to contact the minor’s parent or legal guardian prior to the rendering of medical or dental care. If the emergent nature of the event demands immediate attention, the above listed guardians are authorized to provide the necessary permission needed for required treatment required. The undersigned understands and agrees that YMCA of the East Bay and California YMCA Youth & Government shall not legally or financially liable for any claim arising from the medical, dental, or mental health care provided pursuant to this authorization. I hereby indicate by the signature below that I am the authorized parent or legal guardian for the above minor.
The undersigned hereby agrees to indemnify and hold YMCA of the East Bay harmless from any claim made by or on behalf of said individual arising out of any medical, dental, or mental health care provided pursuant to this authorization. This authorization is given to YMCA of the East Bay for use in conjunction with any event operated by YMCA of the East Bay including transportation to/from the event and shall be valid until revoked in writing by the undersigned.
Code of Conduct Agreeance
For participants: By signing, I acknowledge that I ahve read, understand, and will follow the California YMCA Youth & Governement (Y&G) Code of Conduct at all conferences or YMCA functions.
For parents/guardians of participants: By signing, I acknowledge that I have read and reviewed the Code of Conduct with my child and I accept the responsibility for my child's adherence to it. I also understand that if my child violates the Code of Conduct and is expelled from the program, that I am responsible for their immediate transport home form the conference or YMCA function. This transport shall be done at my expense.
Anonymous Data Collection Release
YMCA of the East Bay (YEB) continually strives to improve the program experience for participants. As part of that process, we work with other YMCA organizations as well as outside researchers to design and implement surveys to learn about experiences and growth during Y&G, as well as standard background information. The information collected is held in confidence by YEB and the researchers have no ability to identify any individual participant. Identifying information will never be released to anyone outside YEB. During the course of our study, we hope to conduct interviews with individual participants. Before that is done, the participant and their parent or guardian will be asked to sign an additional consent form. I have read and agree to these conditions.
Permission is granted for photographs, DVD, video or audio recording of participants that are taken during their participation in the YMCA of the East Bay (YEB) and California YMCA Youth & Government (Y&G) program, in any format including electronic media, to be used by the program for any purpose, including publicity. The participant and his/her parents hereby waive and forever relinquish any rights to such images, waive the right to prior notice of such use, and acknowledge the right for YEB and Y&G to use such images without compensation. I have read and agree to these conditions.
Participant Hotel Accomodations
I understand that hotel sleeping accommodations are shared with other participants up to the maximum allowed by fire code as determined by hotel standards. Delegates seeking reasonable housing accommodations must communicate their request in advance of conferences to their local YMCA who will work with Y&G housing team. If there are any concerns or questions about housing at conferences, contact the YMCA of the East Bay.
Program Guide Acknowledgement
I, as the parent/guardian, hereby understand and acknowledge that I have read or in the process of reading the program guide for the Youth & Government’s Model Legislature & Court program. By signing this form, I acknowledge that I understand the provisions, and agree to abide by the rules, polices, and standards set forth in the guide. If I need further clarification, I will contact the YMCA.
Signature of Agreement
I have read, understand, and agree to the statements above