The Bridging the Intergenerational Gap Program

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for the participant to participate in any and all activities prepared by Illuminating the Youth during the selected activities. In exchange for the acceptance of saidparticipant’s candidacy by Illuminating the Youth. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Illuminating the Youth and all its respective officers, agents, and representatives from any and all liability for injuries to said participant arising out of traveling to, participating in, or returning from selected workshop sessions.

In case of injury to said psticipant, I hereby waive all claims against  Illuminating the Youth. including all chaperone and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

 

Media Release

I, hereby grant permission to Illuminating the Youth and all its respective officers, agents, and representatives to use the participant's image, likeness, and/or testimonial in various media formats, including but not limited to:

- Photographs
- Videos
- Audio recordings
- Written testimonials
- Social media posts

for the purpose of promoting Illuminating the Youth's and all its respective officers, agents, and representatives programs, services, and events. I understand that these media materials may be used in various contexts, including:

Medical Release and Authorization

As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child/participant, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named participant. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Illuminating the Youth and its affiliates including Directors, Coaches, volunteers and parents to provide the needed emergency treatment prior to the participant’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child/participant, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.