Jonesboro Youth City Government 2025-2026 Application

I, the undersigned Parent/Legal Guardian of "Member", hereby consent to and give my permission for the following: 1.) That the Member has my consent and permission to participate as a member of the JONESBORO YOUTH CITY GOVERNMENT in all activities, which may be held in venues outside of the Jonesboro City Center. 2.) I acknowledge that the Member will be participating at his/her own risk and I, on his/her and my own behalf, hereby release, discharge and indemnify the City of Jonesboro and its subsidiaries from all liability for injury to person or damage to property of myself and the Member arising out of participation in, and transportation associated with, JONESBORO YOUTH CITY GOVERNMENT. 3.) In permitting the Member to participate, I am specifically granting permission to The City of Jonesboro and The JONESBORO YOUTH CITY GOVERNMENT to use the likeness, voice and words of the Member in television, radio, films, newspapers, magazines and other media, and in any form not heretofore described, for the purpose of advertising or communicating the purposes and activities of the JONESBORO YOUTH CITY GOVERNMENT and appealing for funds to support such activities. 4.) In the event of an accident or illness during JONESBORO YOUTH CITY GOVERNMENT activities, I understand that reasonable effort will be made to contact the parent/guardian or emergency contact immediately. However, I am aware that if the injury or illness appears serious and the parent/guardian or emergency contact cannot be reached, the adult in charge will secure emergency medical care as needed. By signing below you affirm that you have read and agree to the expectations and guidelines of the City of Jonesboro and The JONESBORO YOUTH CITY GOVERNMENT. 

“Activity” is defined as attending and participating in JONESBORO YOUTH CITY GOVERNMENT planned events including, but not limited to, presentations, meal events and teambuilding. “Minor” is defined as someone who is under the age of 18. In consideration of being given the opportunity to participate in the Activity, I, as the parent or legal guardian of the Minor, for the Minor, myself, our personal representatives, heirs, assigns, and next of kin do hereby acknowledge and agree as follows: 1. Assumption of Risk: I hereby assume any and all risks associated with the Minor’s participation in the Activity or related activities and all responsibility for losses, costs, and damages incurred as a result of the Minor’s participation in the Activity. The Minor agrees to act with due regard for his/her own safety and the safety of others. I agree to supervise the Minor throughout the Activity or have appointed another responsible adult to do so to ensure the safety of the Minor and others. 2. Release of Liability: I fully release, covenant not to sue, and hold harmless The City of Jonesboro and any of its agents, directors, members or employees for any and all claims arising, directly or indirectly, out of the Activity including, but not limited to, all claims for injuries, demands, rights, promises, damages, liabilities, or losses sustained during the Activity, including any claims for invasion of privacy, appropriation of likeness, or defamation. I also agree to hold harmless and indemnify the City of Jonesboro from any and all liability, cost, or expense, including attorney’s fees, claimed by any other person arising directly or indirectly from an action or inaction by the Minor during the Activity. 3. Media Release: I fully authorize the City of Jonesboro and its affiliates to use the Minor’s name, likeness, or image for purposes of advertising, marketing, or promotion without further compensation, except where prohibited by law; and I further acknowledge and agree that any images or recordings obtained or procured by the City of Jonesboro in the course of the Activity and preparation for the Activity shall be the sole and exclusive property of the City of Jonesboro and may be published, broadcast, reproduced and used in any media at the exclusive discretion of the City of Jonesboro including on the internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assigns and personal representatives.