Youth Agreement
Consent & Release of Liability Waiver
Appalachian Youth to Youth
I, the student, and my parent or guardian agree to the following terms and conditions for involvement in Appalachian Youth to Youth and extend my consent, release of liability, waiver of right to sue, and assumption of all risks under the following terms:
1. Consent. I, and my parent/guardian consent to my participation in Appalachian Youth to Youth under the terms of this Agreement. I will follow any instructions provided by the Appalachian Youth to Youth Advisor, Partners Aligned Toward Health (PATH) staff, and YMCA staff.
2. Youth Agreement. I, and my parent/guardian, agree to the following terms of participation in Appalachian Youth to Youth:
A. I will refrain from behavior that harasses, intimidates, or bullies others, both in person or through electronics, including phone calls, texting, social media, and email.
B. I will follow school policy on avoiding behaviors that are considered offensive touching, sexual harassment, and indecent exposure.
C. I will not wear clothing as outlined in school policies that have offensive graphics, language, or images.
D. I will respect other participants and Appalachian Youth to Youth leaders through using appropriate language, including electronic forms of communication.
E. I will respect YMCA property, Mitchell and Yancey County Transportation property, Appalachian Youth to Youth property, and the property of any site visited as a group.
F. I will follow all Mitchell and Yancey County Transportation passenger conduct policies and act respectfully toward the driver and all other passengers.
G. I will listen and follow the directions of the Youth to Youth advisor and school club sponsor.
Participants who violate one or more of these agreements will be subject to consequences including verbal and written warnings, loss of special privileges like field trips, notice given to parent/guardian and the school principal, and temporary or permanent removal from Appalachian Youth to Youth.
3. Student Communication Permission. I, the parent/guardian, understand how important regular and clear communication is and therefore grant permission to Appalachian Youth to Youth, a program of Partners Aligned Toward Health, to use the Remind App as the primary form of direct communication with my student as well as student email and public social media posts as other forms of electronic communication when appropriate. I understand it is my responsibility to contact Tara Brozanski if these methods of communication do not work for me.
4. Parent and Guardian Communication. I, the parent/guardian, understand how important regular and clear communication is and therefore grant permission to Appalachian Youth to Youth, a program of Partners Aligned Toward Health, to use the Remind App as the primary form of direct communication with me as well as email and public social media posts as other forms of electronic communication when appropriate. I understand it is my responsibility to contact Tara Brozanski if these methods of communication do not work for me.
In case of emergency, Appalachian Youth to Youth staff will use all reasonable methods of communication to contact the parent or legal guardian or listed emergency contact regardless of methods listed above.
5. Survey Permission. I, the parent/guardian, understand that surveys will be given to assess program effectiveness and be used for program improvement by program staff. These surveys will be anonymous and voluntary. Students may skip any questions they do not wish to answer and may stop taking the survey at any point without penalty. Aggregate data will be used for grant requests to ensure this program is available free of charge to students and families. I understand it is my responsibility to contact Tara Wright if I have questions regarding the survey or would like to see a copy of the survey.
6. Release Waiver. I, on behalf of myself, my heirs, personal representatives, successors and assigns release, waive and discharge Partners Aligned Toward Health (parent organization to Appalachian Youth to Youth), The Williams YMCA of Avery County and Mitchell County, the Mitchell County School System, and their employees, officers, directors, successors and assigns from all claims or liability of any kind or nature that may directly or indirectly result in personal injury, illness, death or property damage, however caused while I am participating in Appalachian Youth to Youth meetings/field trips/activities. I, on behalf of myself, my heirs, personal representatives, successors, and assigns agree not to commence litigation, seek arbitration or make a Claim against the Released Parties.
Because I am under the age of 18, my parent or legal guardian, by signing below, also consents to my release and he/she agrees that this release shall be binding upon him/her as my parent or legal guardian as to me, my heirs, personal representatives, successors and assigns. My parent or guardian also promises, by signing below to defend, indemnify and hold Partners Aligned Toward Health, the Williams YMCA of Avery County and Mitchell County, and Mitchell County Schools harmless from any claim asserted by me against Partners Aligned Toward Health, the Williams YMCA of Avery County and Mitchell County, and Mitchell County Schools, including their employees, officers, directors, successors and assigns, if I should repudiate this release after obtaining adulthood.
7. Assumption of Risk. I, and my parent/guardian understand that participation in Appalachian Youth to Youth may include activities that could cause harm to me, including physical activities such as walking, swimming, hiking, and physically active games; carrying/moving materials needed for activities; field trips; and traveling in buses or vans with the Williams YMCA of Mitchell County and/or Mitchell County Transportation. I and my parent/guardian recognize that there are inherent risks associated with those activities and I expressly assume all risks and dangers of personal injury, death, illness, and property damages which could occur as a result of my participation in Appalachian Youth to Youth.
8. Emergency Care and First Aid. I, and my parent/guardian understand that the safety of my student is of primary concern to Partners Aligned Toward Health (PATH), and therefore give permission to Appalachian Youth to Youth staff and YMCA staff to provide first aid (Bandaids, bandages, anti-septic, ice packs) for my student and take the appropriate measures, including contacting the Emergency Medical Service (EMS) system and arranging for transportation to the nearest emergency medical facility, if warranted. I understand that Appalachian Youth to Youth will make every attempt to contact me, the parent/guardian, if my student is ill or injured. In the event of an emergency where I, the parent/guardian, cannot be reached I give my permission for the adult staff of Appalachian Youth to Youth and the Williams YMCA of Avery County and Mitchell County to act on my behalf in requesting emergency medical care for my student. I acknowledge that no guarantees have been made to me as to the effect of such examinations or treatment on the condition of my student and that I am responsible for all reasonable charges in connection with the care and treatment rendered to my student during this period.
9. Photographic/Video Consent and Release. Unless the Opt-Out section is selected below, my parent/guardian and I consent to Partners Aligned Toward Health (PATH) (parent organization to Appalachian Youth to Youth) and the Williams YMCA of Avery County and Mitchell County taking and using photographs, images, video, or audio recordings of me in connection with my participation in activities with Appalachian Youth to Youth. My parent/guardian and I give PATH all right, title, and interests in any and all photographs, images, videos, or audio recordings of me in connection with my participation in Appalachian Youth to Youth including any royalties, proceeds, or other benefits that could be derived from such photographs or recordings. My parent/guardian and I also grant permission for the use of my picture for promotional or publicity purposes, and consent that it may be published in electronic communications, mass media publications, on the Partners Aligned Toward Health and Williams YMCA of Avery County and Mitchell County web/internet sites or shown in video, television, or movie presentations broadcast, telecast or written account of PATH or YMCA programs and services.
Students in Youth to Youth may have opportunities to be featured in the local newspaper, the local radio station, Partners Aligned Toward Health or YMCA e-newsletters, the Appalachian Youth to Youth website, Appalachian Youth to Youth social media channels, and other outlets in connection with Youth to Youth projects.
10. Travel Permissions for Monthly YMCA Outings. I consent for my child/student to ride with Mitchell County Transportation and/or the Williams YMCA of Mitchell County on passenger vans to attend monthly outings to the Mitchell County YMCA facility in Spruce Pine (203 Pinebridge Avenue) from the YMCA Healthy Living Center (275 Oak Avenue). The Youth to Youth advisor(s) will give advanced notice for each of these outings to parents and guardians through the Remind app.
11. Other. I agree that the provisions in this Agreement are intended to be as broad and inclusive as permitted by the laws of the State of North Carolina and that this Agreement shall be governed by and interpreted in accordance with the laws of the State of North Carolina. I agree that in the event that any clause or provision of this Agreement shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Agreement which shall continue to be enforceable.