Permission Form & Liability Waiver

Permission Form & Liability Waiver

This covers all activities teens participate in throughout Journeymen's programs. For questions, please contact us by email: journeymenasheville@gmail.com
I give my informed consent and permission for my child to participate with Journeymen and its activities.*

Yes
I agree to have my child follow mentoring program guidelines and understand that a violation on my child’s part may result in suspension and/or termination of mentorship.*

Yes
I, Parent/Guardian (Full Name)* of Child (Full Name)*, hereby allow my son to participate in activities with and hold Journeymen harmless from liability relating any potential incidents that may occur around activities or outings.

In consideration of the services of Journeymen, including all officers, directors, staff, leaders, volunteers, affiliates, and all other persons and entities acting for them or on their behalf (hereinafter collectively referred to as “Journeymen”) and the right to engage in our activities as a participant, I hereby freely and voluntarily agree to release, indemnify, and hold Journeymen harmless on behalf of myself, my family, personal representatives, and estate.
Journeymen is NOT therapeutic, political, or religious; we seek to listen and recognize the gifts in boys regardless of background. Our mission is to help boys on their paths to becoming men of integrity, and we have been serving this purpose in the community since 2008.*

I understand
I release the Journeymen Mentoring Program of all liability of injury, death, or other damages to me, my child, family, estate, heirs, or assigns that may result from his participation in the program, including but not limited to transportation, and hold harmless any Journeymen mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional.*

Yes
MEDIA RELEASE: I, parent/guardian of child, consent that Journeymen may photograph and videotape events and activities to help promote future events, activities, and programs. I give my consent and agree that Journeymen and affiliates may: 1) Interview, record, and/or photograph us, and 2) Use our names (abbreviated for privacy; John J.), images, and likeness in verbal presentations, conferences, interviews, written publications, and other forms of communications. I recognize that Journeymen shall have the exclusive rights to the materials indicated here, including copyrights and proprietary rights, and I assign to Journeymen any right in relation to the materials.*

I agreeI do not agreeOther
Parent/Guardian Email*
example@example.com
Parent/Guardian Best Contact Phone #*
Please enter a valid phone number.
Method(s) of Communication*

EmailTextOther
Transportation

I (parent/guardian) will drive my sonMy son can drive himselfMy son will carpool with another J-men friendMy son may carpool with a community member &/or Journeymen associate*My son will use public transportationOther
I acknowledge and agree that my child may be transported by Journeymen (mentor, staff, or representative) while participating in the our program(s), and that such transportation is voluntary and at his own risk.

Yes
Emergency Contact*
Should differ from the person listed above as the primary contact.
Allergies? Special Diet?
Anything else we should know?
Please do share any relevant medical information. Our medically-trained staff does its best to uphold HIPAA standards for security & privacy.
Signature*

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