YOUTH & GOVERNMENT

We are so excited to see you apply to become a delegate in Youth & Government!

There are 2 steps that you need to complete in order to register for Y&G and be eligible to go on the conferences with us.

1. Y&G East Bay Application: Get started below. We suggest you allocate around 20 minutes to fully complete the application. Make sure a parent/guardian is around because the application requires their signature.

2. Payment for Y&G Program Fees: Once you submit the Y&G East Bay Application, you will receive an email with instructions on how to make a payment for program fees on the YMCA of the East Bay's website.

If you miss either of the above steps by the deadline, you will not be able to go on the conferences with us. Make sure you work through the steps carefully so you do not miss out!

I have read through the Y&G East Bay's program guide and understand the event dates, deadlines, enrollment process, program fees, late fees, and refund policy.

Parent/Guardian 1 - PRIMARY adult and emergency contact

Parent/Guardian 2 - SECONDARY adult and emergency contact

The YMCA-PG&E Teen Center has my permission to make contact or release the named minor at any time to the following individual in case of an emergency if the parent(s)/guardian(s) are unavailable:

IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1. THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused bv the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.
   
   
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.
   
   
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA.

THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.

Signature of Agreement I have read and understand this document and release

Program Fee and Payments

Our program fee is $1,401. Only credit/debit cards will be accepted - no cash or checks.

Program fees will be divided into 3 installments of $467. Your payment method will be set up for automatic payments to be made on:

On October 2th

November 2th

December 2th

Financial Aid

Financial aid is available and is based on the student's family income and size. Maximum amount provided is 80%. Deadline for financial aid is September 18. Submit an application by going to www.ygeastbay.org/mlc_aid

Late Fee

A late fee of $35 will be applied if installments are paid after the deadline. Failure to pay the required program fees before a conference will result in the student not attending the conferenceor planned activitiesfor Youth and Government.

Refund Policy

Once a payment/draft date has passed, the fee is no longer refundable. Payments paid are non-refundable/non-transferable in the event the student does not complete the program or attend any of the conferences. Refunds must be requested, in writing, 7 days prior to a payment/draft in order for all future payments to be refunded or canceled.

Agreement

• I agree to pay by the date listed above for my child’s Youth and Government program fees.
• I understand there is a $35 late fee for fees paid after the due date.
• I understand the fees and payments paid are non-refundable/non-transferable in the event my child does not complete the program or attend any of the retreats or conferences.
• I understand refunds must be requested, in writing, 7 days prior to a payment/draft in order for all future payments to be refunded or canceled.
• I understand failure to pay the required program fees will result in my child not attending the conferences or planned activities for Youth and Government.
• By signing this Program Payment Agreement, I understand and agree to my financial obligation to the YMCA of the East Bay and Youth and Government.

IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1. THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused bv the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.
   
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.
   
   
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA.

THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.

Signature of Agreement I have read and understand this document and release

Please read the following. Every section must be agreed upon in order to participate in this program.

Medical Release

I hereby authorize YMCA of the East Bay and its authorized director and/or leaders (collectively the YMCA) or an authorized representative of the Y&G program in conjunction with the local YMCA to act as guardians for the above named individual. The guardianship grants authority to consent to any medical, dental, surgical or mental health diagnosis or treatments, and hospital care to be rendered to the individual under general or special supervision and upon advice of a health care provider licensed under the laws of the state or any other jurisdiction in which emergency medical care is sought. For the purpose of medical care or dental care obtained in the State of California, this authorization is given pursuant to the provisions of section 25.8 of the California Family Code, as amended. I have read and agree to these conditions.

For parents or guardians with participants under 18, all efforts will be made to contact the minor’s parent or legal guardian prior to the rendering of medical or dental care. If the emergent nature of the event demands immediate attention, the above listed guardians are authorized to provide the necessary permission needed for required treatment required. The undersigned understands and agrees that YMCA of the East Bay and California YMCA Youth & Government shall not legally or financially liable for any claim arising from the medical, dental, or mental health care provided pursuant to this authorization. I hereby indicate by the signature below that I am the authorized parent or legal guardian for the above minor.

The undersigned hereby agrees to indemnify and hold YMCA of the East Bay harmless from any claim made by or on behalf of said individual arising out of any medical, dental, or mental health care provided pursuant to this authorization. This authorization is given to YMCA of the East Bay for use in conjunction with any event operated by YMCA of the East Bay including transportation to/from the event and shall be valid until revoked in writing by the undersigned.

Code of Conduct Agreeance

For participants: By signing, I acknowledge that I ahve read, understand, and will follow the California YMCA Youth & Governement (Y&G) Code of Conduct at all conferences or YMCA functions.

For parents/guardians of participants: By signing, I acknowledge that I have read and reviewed the Code of Conduct with my child and I accept the responsibility for my child's adherence to it. I also understand that if my child violates the Code of Conduct and is expelled from the program, that I am responsible for their immediate transport home form the conference or YMCA function. This transport shall be done at my expense. 

Anonymous Data Collection Release 

YMCA of the East Bay (YEB) continually strives to improve the program experience for participants. As part of that process, we work with other YMCA organizations as well as outside researchers to design and implement surveys to learn about experiences and growth during Y&G, as well as standard background information. The information collected is held in confidence by YEB and the researchers have no ability to identify any individual participant. Identifying information will never be released to anyone outside YEB. During the course of our study, we hope to conduct interviews with individual participants. Before that is done, the participant and their parent or guardian will be asked to sign an additional consent form. I have read and agree to these conditions.

Media Release

Permission is granted for photographs, DVD, video or audio recording of participants that are taken during their participation in the YMCA of the East Bay (YEB) and California YMCA Youth & Government (Y&G) program, in any format including electronic media, to be used by the program for any purpose, including publicity. The participant and his/her parents hereby waive and forever relinquish any rights to such images, waive the right to prior notice of such use, and acknowledge the right for YEB and Y&G to use such images without compensation. I have read and agree to these conditions.

Participant Hotel Accomodations

I understand that hotel sleeping accommodations are shared with other participants up to the maximum allowed by fire code as determined by hotel standards. Delegates seeking reasonable housing accommodations must communicate their request in advance of conferences to their local YMCA who will work with Y&G housing team. If there are any concerns or questions about housing at conferences, contact the YMCA of the East Bay.

Program Guide Acknowledgement 

I, as the parent/guardian, hereby understand and acknowledge that I have read or in the process of reading the program guide for the Youth & Government’s Model Legislature & Court program. By signing this form, I acknowledge that I understand the provisions, and agree to abide by the rules, polices, and standards set forth in the guide. If I need further clarification, I will contact the YMCA.

Signature of Agreement 
I have read, understand, and agree to the statements above

I am 18 years of age or older and, if not, my parent or legal guardian has also provided their consent by signing below.

Consent & License. For my participation in activities to be conducted by the YMCA of the East Bay (“YEB”) and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of:

• video film or footage of me,
• sound track recordings of me
• photo reproductions of me
• any narrative account of my experience

My consent includes a perpetual license to YEB and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from YEB or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services.

Ownership, Confidentiality, and Shared Use. With respect to any of the above uses, I further agree:

• All works shall belong to YMCA of the East Bay;
• YEB has no duty of confidentiality regarding any licensed uses;
• YMCA of the East Bay shall exclusively own all known or later existing rights to the uses throughout the world;
• YEB and collaborating third-parties may use any video film, footage, sound track recordings and photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. Release from Liability. I agree that my consent is irrevocable. I hereby release and discharge YEB and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

I am the parent or legal guardian of (child’s name). I hereby consent and grant the licenses detailed in the foregoing on behalf of my minor child.

Each participant in all CALIFORNIA YMCA YOUTH & GOVERNMENT, YMCA OF METROPOLITAN LOS ANGELES (hereinafter referred to as “Y&G” and Y-LA) programs has the right to a safe environment. The YMCA’s core values of Caring, Honesty, Respect, and Responsibility should be in the forefront of every delegate, advisor, volunteer and staff member’s mind and actions. Y&G values the diversity of views, expertise, opinions, backgrounds, and experiences reflected among its members and the broader community, and is committed to providing a safe, productive and welcoming environment for all participants of meetings and events. This Code of Conduct is important to promoting diversity and creating a safe, inclusive, orderly, respectful, supportive, and collaborative environment for all individuals.

All Y&G meetings and event participants – including, but not limited to, attendees, speakers, volunteers, exhibitors, staff, members of the media, vendors, and service providers (hereinafter “participants”) – are expected to abide by this Code of Conduct. This Code of Conduct applies in all venues, including ancillary events and social gatherings, and on-line forums and discussions hosted by or associated with Y&G.

Y&G reserves the right and authority to interpret, administer, and enforce the Code of Conduct and to administer any disciplinary action deemed necessary, to prescribe exceptions or accommodations thereto, and may delegate this authority as deemed necessary. Local YMCAs and/or Delegations may establish and enforce more stringent expectations for their participants so long as local rules do not conflict with or seek to diminish the standards contained in this Code of Conduct.

As a participant of California YMCA Youth & Government programs, I agree to uphold the following Code of Conduct:

1. I acknowledge that my personal behavior reflects upon the program, my delegation, my local YMCA, my school, my family and myself. I am responsible for preserving the reputation of the program through responsible and professional conduct in accordance with the YMCA’s Core Values.
   
   
2. I agree to display identifying information during all Youth & Government activities and events:
   
   
   1. In person: I agree to wear my badge at all times when outside my assigned room. I shall wear my badge above the waist, in a prominent location, where it is easy for other delegates, volunteers and staff to see.
      
      
   2. Virtual programming: I agree to participate using my first and last name, along with any identifying information (delegation, group, etc as requested by advisors or volunteers as my display name on all virtual program platforms and to refrain from using “virtual background” options that would distract from participation. I agree to participate with my camera on unless otherwise instructed by program staff.
      
      
3. I agree to communicate openly, with respect for other participants, critiquing ideas rather than individuals, treating all participants with kindness, respect and consideration, value a diversity of views and opinions.
   
   
4. I agree to be punctual and attend the entirety of all scheduled program functions, activities, meetings, and training sessions during Y&G conferences.
   
   
5. I agree to use technology and social media in ways that promote Caring, Honesty, Respect & Responsibility, the Core Values of the YMCA, during all Y&G activities or events.
   
   
6. I agree to abide by the dress code provided by the program for any Youth & Government Activity.
   
   
7. I agree to refrain from any kind of harassment or intimidation by words, gestures, body language, or other inappropriate behavior, online or in person. I agree not to create or send hurtful or cruel messages or content through any medium. I agree to not post texts, photos, or videos received from others without their consent. I understand that intimate or sexual behavior is not allowed and that I am prohibited from sharing sexually explicit content.
   
   
8. I understand that I am subject to all local, state, and federal laws and regulations while participating in Youth & Government programming.
   
   
9. I agree to treat all public and private facilities and its staff with respect and in accordance with their rules. I understand that I am legally and financially responsible for any defacing, removal, or willful damage of or to public or private property including, but not limited to the property of the state of California, fellow participants, advisors, YMCA staff, organizations, businesses, hotels, and program facilities.
   
   
10. I understand that any activity that endangers the health and safety of myself or others is prohibited. I understand that weapons of any kind and items that could cause injury or damage to participants and/or property are strictly forbidden at any Youth & Government in-person conference or event.
    
    
11. I agree to refrain from the use, possession and/or concealment of any: tobacco product, Electronic Nicotine Delivery Systems (ENDS), vape devices, alcohol, prescription medication not prescribed to me, non-prescription/illegal drugs during any Y&G conference or event. Regardless of a medical doctor’s prescription, consumption or possession of cannabis products and paraphernalia is prohibited at all Youth & Government functions.
    
    
12. For in-person conferences, I agree to observe established hotel quiet hours and curfews. I agree not to change assigned hotel rooms without my advisor’s consent. I agree to not enter any hotel room other than my own, unless an advisor is present.
    
    
13. I understand that I am not permitted to drive myself to or from any Youth & Government in-person conference. Advisors seeking to drive during a conference must obtain clearance through Youth & Government. In all cases, liability is assumed by the local delegation.
    
    
14. I understand that all participants share equally in the responsibility for their actions when violations of the Code of Conduct are witnessed. I also understand that those who are present when a violation occurs shall, by their own choice, be considered a participant in the violation. I understand participants found to have been present when a violation occurs who did not inform an advisor immediately are also considered to be in violation of the Code of Conduct.
    
    
15. I understand that to ensure the safety of all participants, Y&G and delegations reserve the right, if deemed necessary, to search baggage, rooms, and persons. Items may be confiscated by program staff or designee if deemed in violation of the Code of Conduct.
    
    
16. I understand that all participants must register to attend Y&G activities and events. I agree not to invite non-registered participants to Y&G events or activities. I agree not to share virtual programming links, passwords, or log-in credentials with anyone who is not a registered program participant.

I understand that disregarding of any part of this Code of Conduct or deciding to behave in a manner inconsistent with the YMCA’s Core Values of Caring, Honesty, Respect, and Responsibility, in person or online, may negatively impact my status as a Youth & Government delegate, advisor, volunteer, participant, guest, and/or leadership candidate or applicant.

I have read and understand the California YMCA Youth and Government Code of Conduct. I agree to follow the Code of Conduct. I understand that if I fail to adhere to the Code of Conduct’s standards of conduct, I may face consequences, up to and including my immediate expulsion from the California YMCA Youth & Government Program and that I may be sent home at my own expense. I also understand that violation of any law may be addressed by local law enforcement in addition to any discipline imposed by California YMCA Youth and Government.