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28Questions
  • 1
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  • 2
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    Pick a Date
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  • 3
    Please Select
    • Boy
    • Girl
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  • 4
    Please Select
    • Kindergarten
    • 1st Grade
    • 2nd Grade
    • 3rd Grade
    • 4th Grade
    • 5th Grade
    • 6th Grade
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  • 5
    Please Select
    • Ebenezer Elementary
    • Ebinport Elementary
    • York Road Elementary
    • Old Pointe Elementary
    • Oakdale Elementary
    • Independence Elementary
    • Cherry Park Elementary
    • Richmond Drive Elementary
    • India Hook Elementary
    • Mt Gallant Elementary
    • Palmetto Elementary
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  • 6
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  • 7
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  • 8
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  • 9
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 10
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  • 11
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  • 12
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  • 13
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  • 14
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  • 15
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  • 16
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  • 17
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  • 18
    List all allergies and the severity
    Please Select
    • ☐Exercise
    • ☐ Weather/temperature changes
    • ☐ Pollen
    • ☐ Dust
    • ☐ Animals
    • ☐ Smoke
    • ☐ Respiratory illness
    • ☐ Other: ______________________________________________________________
    • ☐ No known allergies
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  • 19
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  • 20

       Any medical condition, diagnosis, disability, or health-related need that program staff should know about?

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  • 21
    I, the undersigned parent or legal guardian, authorize A Hid In Treasure Youth Empowerment Initiative, Inc. (A Hid In Treasure YEI) and its designated staff, volunteers, or authorized personnel to provide reasonable first aid and basic care to my child when necessary while my child is participating in A Hid In Treasure YEI programs, activities, field trips, recreational activities, or transportation.In the event of an illness, injury, accident, allergic reaction, or other medical emergency, I authorize A Hid In Treasure YEI to contact emergency medical services and, when reasonably necessary, obtain or arrange for appropriate medical evaluation and treatment for my child.I understand that reasonable efforts will be made to contact me or my designated emergency contact as soon as practicable. I also understand that this authorization does not replace any separate medication authorization or medical action plan required for prescription medications, asthma inhalers, epinephrine auto-injectors, or other specialized medical care.
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    • Yes
    • No
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  • 22
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  • 23

    LIABILITY WAIVER, ASSUMPTION OF RISK & RELEASE

    A Hid In Treasure Youth Empowerment Initiative, Inc.

    I, the undersigned parent or legal guardian, understand that participation in programs and activities sponsored, organized, supervised, or facilitated by A Hid In Treasure Youth Empowerment Initiative, Inc. (“A Hid In Treasure YEI”) may involve recreational, educational, athletic, transportation, field trip, and other activities that involve inherent and reasonably foreseeable risks, including the risk of accident, injury, illness, property damage, or other loss.

    I understand that A Hid In Treasure YEI will take reasonable measures to provide appropriate supervision and maintain a safe environment; however, no activity can be guaranteed to be completely free from risk.

    ASSUMPTION OF RISK

    I knowingly and voluntarily permit my child to participate in A Hid In Treasure YEI programs and activities and acknowledge that participation may involve risks that cannot be completely eliminated, including risks associated with sports, physical activities, recreational activities, field trips, transportation, playgrounds, swimming, travel, and activities conducted at third-party facilities.

    I understand these risks and voluntarily accept and assume the ordinary risks associated with my child’s participation.

    RELEASE OF LIABILITY

    To the fullest extent permitted by applicable law, I, on behalf of myself and my child, hereby release and discharge A Hid In Treasure Youth Empowerment Initiative, Inc., its directors, officers, employees, staff members, volunteers, mentors, agents, representatives, and authorized program personnel, as well as participating third-party organizations, facilities, activity providers, and partners, from claims for bodily injury, illness, death, property damage, or other loss arising from or related to my child’s participation in A Hid In Treasure YEI programs or activities, including claims based upon the ordinary negligence of a released party, to the extent such release is permitted by South Carolina law.

    This release includes activities occurring at A Hid In Treasure YEI facilities or at third-party locations and, where applicable, transportation provided, arranged, or coordinated by A Hid In Treasure YEI in connection with program activities.

     

    THIRD-PARTY FACILITIES AND PROGRAM PARTNERS

    I understand that certain A Hid In Treasure YEI activities may take place at facilities owned or operated by third parties or may involve third-party organizations, instructors, transportation providers, recreational facilities, or activity providers.

    To the extent legally permissible, I authorize my child to participate in such activities and agree that the release provisions of this agreement apply to the participating third parties identified or designated by A Hid In Treasure YEI in connection with the activity.

    MEDICAL EMERGENCIES

    I understand that A Hid In Treasure YEI may seek emergency medical assistance for my child when reasonably necessary and that a separate Child Medical, Medication & Emergency Authorization Form may be required for medical treatment and medication administration.

    This Liability Waiver and Release does not replace or modify the organization’s medical authorization requirements.

    ACKNOWLEDGMENT AND VOLUNTARY CONSENT

    I acknowledge that I have read this Liability Waiver, Assumption of Risk & Release carefully and understand that I am giving up certain legal rights, including, to the extent permitted by law, the right to pursue certain claims for injuries or losses resulting from the ordinary negligence of a released party.

    I have had an opportunity to ask questions regarding this agreement. I understand its contents and voluntarily consent to my child’s participation in A Hid In Treasure YEI programs and activities.

    By signing below, I certify that I am the child’s parent or legal guardian and have authority to provide this consent.

     

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  • 24
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  • 25
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  • 26
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  • 27
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  • 28
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