Y.A.R.D. Community Service Student Consent Form & Waiver

Y.A.R.D. Community Initiative Minor Consent Form & Waiver

Participants under the age of 18 are required to have this form signed prior to their scheduled program start date.
Minor Demographics:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Parent/Guardian Demographics:
I, the undersigned, am the parent or legal guardian of the minor child named above (hereinafter referred to as "the Volunteer"). I hereby give my full consent for the Volunteer to participate in community service-related and volunteer activities organized by the 144K Advanced Society, Inc.'s (hereinafter referred to as "144KAS") Youth Advocacy, Reform, & Development (Y.A.R.D.) Community Initiative (hereinafter referred to as "Y.A.R.D"). I understand and acknowledge that participation in such activities is entirely voluntary and may involve physical activities, interaction with other volunteers, and exposure to various indoor, outdoor, and/or digital environments, which may carry certain inherent risks.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Emergency Contact & Medical Demographics:
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Medical Conditions (If Any)*
School Contact Information & Demographics:
School Community Service Program Coordinator Contact Name*

First NameLast Name
Program Coordinator Email*
example@example.com
Program Coordinator Phone Number*
Please enter a valid phone number.
Required Community Service Hours*
Required Date Community Service Should be Completed*
Hold Harmless Agreement:
By checking the box below, I am agreeing that...*

In consideration of Y.A.R.D. allowing the Volunteer to participate in its programs, I, on behalf of myself, the Volunteer, and our respective heirs, executors, administrators, legal representatives, and assigns, hereby release, waive, discharge, and hold harmless Y.A.R.D. c/o 144K Advanced Society, Inc., its officers, directors, employees, agents, volunteers, and affiliates from any and all liability, claims, demands, causes of action, or expenses (including reasonable attorneys' fees) of any kind or nature, including but not limited to damages, loss, injuries, or death, that may arise from or in connection with the Volunteer’s participation in any activities or programs conducted by or associated with Y.A.R.D.
Parent/Guardian Acknowledgement, Consent, & Release of Liability:
By checking the boxes below, I acknowledge the following...*

My son/daughter, whose name and age is listed above, to complete their required community service or volunteer work at 144K Advanced Society, Inc.'s Y.A.R.D. Initiative.I understand that the child whose name is listed above will be provided instructions for the safe and responsible performance of their community service/volunteer duties.I understand that 144KAS, Inc. will take reasonable precautions to ensure the safety of its minor program participants. In the event of any accident or injury, I release 144KAS, Inc. and its respective staff from any liability.I have read and understood the details of the Organization, program/activity, including any associated risks. I agree to allow my minor child participate, and I acknowledge the terms and conditions outlined in this consent form
Consent*

I give permission for my minor child to participate in 144K Advanced Society, Inc.'s Y.A.R.D. Community Service Initiative.I give permission for photographs or videos of my minor child to be taken during the program/activity for promotional and/or educational purposes.
Parent/Guardian Signature:

By signing below, I acknowledge that I have read, understood, and agree to the terms and conditions set forth in this Consent and Liability Release Waiver form. I further affirm that I am the legal parent or guardian of the Volunteer and have the authority to sign this agreement on their behalf.
Date*

MonthDayYear
Date
Parent/Guardian Signature*

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Y.A.R.D. Community Initiative Minor Consent Form & Waiver