Mandated Reporting - I understand that all KYCC staff are mandated reporters by California Law, and must report suspected child abuse or neglect of a child under the age of 18 to the Department of Child and Family Services using the resources that we were taught in our trainings. The types of reportable suspected child abuse are physical abuse, sexual abuse, emotional abuse, or neglect. By law, KYCC staff are not allowed to investigate or make any kind of judgement about the particular family. Any reports made are kept confidential and only shared with members of the Supervisor team.

Liability - I hereby grant permission for my child to use all of the program equipment and participate in all activities of the center, and grant permission for my child to leave the premises under the supervision of a KYCC staff member. I do hereby, for my child/children, myself, my heirs, executors and administrators, release and hold harmless KYCC, and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any claims, demands, actions or causes of action which in any way arise related to my child's participation in KYCC programs.

By signing below, I certify that I am the parent and/or legal guardian of the child named in this application. I acknowledge that I have carefully read this document and understand the information therein. I agree to each of the terms and acknowledgments above, and agree to permit my child to participate in KYCC activities.

Occasionally, KYCC program activities may be photographed, videotaped, or audio taped for educational, publicity or fundraising purposes. Please indicate if you give permission for your child and/or their project work to appear in videos, photos or audio recordings without compensation (e.g., as part of brochures, slide shows or program websites).

If, in the judgment of the staff of KYCC the child named above needs immediate care and treatment as a result of any injury or sickness, I do hereby authorize and consent to any x-ray examination, anesthetic, medical, or surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services.

I do hereby agree to indemnify and hold harmless KYCC (including its officers, directors, members and/or volunteers) from any claim by any person whomsoever on account of such care and treatment of said child. It is understood that a good faith attempt shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached. Further, it is understood that the undersigned will assume full responsibility for any such action, including payment of costs.

Program Dates: January 5 - January 9, 2026

Location: 1230 Menlo Ave., Suite 100, Los Angeles, CA 90006

Contact: Gladys Ramos | gramos@kyccla.org | (213) 365-7400 Ext. 5634

Dates	Activities	Hours
January 5th	Mental Health & Wellness	12:00pm - 5:00pm
January 6th Field Trip	College Tour to Loyola Marymount University	9:30am - 3:00pm
January 7th	Community Building and Skill Building	12:00pm - 5:00pm
January 8th Field Trip	Koreatown Tour	9:30am - 3:00pm
January 9th	Ceramics and Art	12:00pm - 5:00pm

To ensure a smooth and effective experience for all participants, attendance is mandatory for all sessions of the Winter Break Program. We expect full participation throughout the entire week.

• Mandatory Attendance: Participants must attend every session in its entirety. Missing any part of a session will count as an absence.
• Advance Notice for Absences: If the participant is unable to attend a session due to illness or an emergency, parent/guardian must notify us at least 24 hours in advance. This allows us to manage any changes and accommodate other participants on the waitlist.
• Unreported Absences: Missing a session without prior notice or communication may result in losing your spot, which could be offered to another participant.

As part of ensuring safety and accountability, we have established the following guidelines for attendance, sign-in/out procedures. Unless we have been specifically informed that a parent or guardian will be picking up the student, students in grades 6–12 are permitted to sign themselves out and leave independently.

• Sign-In: Upon entering the classroom, students are expected to record their name and time of arrival.
• Sign-Out: Students must sign out when they leave the program, including the time they are departing.

As a participant of KYCC's College Corner Winter Programming, my child will attend the scheduled field trips listed below. I understand and agree to the following:

• KYCC will provide transportation to and from each field trip, supervision by staff and/or volunteers, and age-appropriate activities or learning opportunities during the trip.
• Students may bring additional money for snacks, but it is not required.
• I may opt my child out of any trip below by selecting "Not Attending."
• On field trip days, onsite programming will be closed for College Corner students.

Tuesday, January 6th 2026	Loyola Marymount University Departure: 1230 Menlo Ave. Suite #100, LA, CA 90006 at 9:30am Return: 1230 Menlo Ave. Suite #100, LA, CA 90006 at 3:00pm
Thursday, January 8th 2026	Koreatown Tour Departure: 1230 Menlo Ave. Suite #100, LA, CA 90006 at 9:30am Return: 1230 Menlo Ave. Suite #100, LA, CA 90006 at 3:00pm

I give permission for my child to participate in the KYCC College Corner Winter Program field trips I have selected above. I understand that my child will be supervised by KYCC staff and/or volunteers, and that a staff member will be available throughout each trip. I release KYCC, its Board of Directors, and employees from all liability related to mychild’s participation. I understand that unsafe behavior may result in my child being sent home early at my expense.

Photography/Videotaping/Other Imaging/Audio Recording

I hereby give my consent to HOLA to use videotaped recordings, audio recordings, photographs, or other images made of my child during my child's participation in classes administered by HOLA for educational, publicity, and fundraising purposes. I further acknowledge and agree to the following:

• Once the recordings have been completed, HOLA will be entitled to edit, modify, distribute or use the recordings indefinitely, as HOLA sees fit in its discretion.
• HOLA has the right to reproduce, distribute, sell, transmit, publish, exhibit or otherwise use any and all photographs, video or other materials in which my child may appear, or any portion thereof.
• Although HOLA intends to use the recordings for educational, publicity, and fundraising purposes only, it is possible that copies of the recordings may be seen, copied, distributed or transmitted by others without HOLA's consent.
• I agree that these video and/or audio recordings will remain the property of HOLA.
• I hereby waive any right that I may have to inspect or approve the copies or recordings of any versions or editing of them, or any text or other information that may accompany the copies or recordings. I thereby release, discharge, and agree to save harmless HOLA, its successors and assigns, and all persons acting under its permission or authority, and those for whom it is acting, from any liability by virtue of any blurring, distortion or alteration, whether intentional or otherwise, that may occur or be produced in the taking of such recordings or in any subsequent processing thereof, as well as any publication or use thereof.

I certify that I am the parent or legal guardian of the child named above and fully authorized to give this Consent. I have read this entire Consent prior to signing, and I am fully familiar with the contents thereof. This Consent shall be binding upon me, my heirs, legal representatives and assigns.

Entry into HOLA's campus

This Notice, Waiver and Release of Liability is sent to inform you of certain risks regarding your entry into HOLA campuses and partner sites operated by HOLA, whether during normal working hours or otherwise. HOLA's priority is the health and safety of our team members, visitors, students, and communities. Entry into HOLA or other related activities could increase your risk of contracting COVID-19, which may result in severe and permanent damage to your health, notwithstanding any preventative measures that HOLA has implemented. According to the Center for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are especially vulnerable. Additionally, you are not permitted to enter HOLA if you feel sick or feverish, believe you may have come in recent contact with someone who has had similar symptoms or tested positive for COVID-19, or have recently been advised by a health care provider or public health official to self-quarantine.

Waiver of Liability & Informed Consent

By signing this Agreement, I, for myself, and for my heirs, successors, assigns, and personal representatives, understand and agree that I knowingly assume the risk of any and all claims, proceedings, losses, liabilities, damages, costs, and expenses of any kind or nature whatsoever (including without limitation reasonable attorneys' fees), arising out of or related to entry into HOLA, including but not limited to, personal injuries, property damage or exposure to COVID-19. This waiver covers both my entry onto HOLA's campus as well as that of my minor child(ren) as discussed more fully below.

I further agree to defend, indemnify, and hold harmless HOLA and its present and future parents, subsidiaries, divisions, affiliates, related entities, successors, assigns, and any and all of its and their past, present and future directors, officers, agents, trustees, heirs, administrators, attorneys, and assigns (collectively the "Releasees") from any and all claims, proceedings, losses, liabilities, damages, costs, and expenses of any kind or nature whatsoever (including without limitation the Company's reasonable attorneys' fees) arising out of or related to my/my child(ren)'s entry into HOLA, whether due to the negligence of Releasees or otherwise.

I understand and agree that I will not be covered by or eligible for any insurance coverage (if any) provided by Heart of Los Angeles Youth (HOLA), including, but not limited to, medical, property, automobile, accident, and liability insurance, and Worker's Compensation benefits.

If I am signing this notice, waiver, and release as the natural parent or legally appointed guardian of a minor (the "Minor"), I further represent, warrant and agree as follows: (i) I am entitled to the full control and custody of Minor, and am authorized to enter into this agreement with respect to Minor; (ii) I have read and am familiar with the provisions of this agreement, I consent to the execution of this agreement by Minor, and that such consent shall be deemed sufficient for the purposes of all applicable laws and statutes; and (iii) I agree, on behalf of myself personally and Minor, to be bound by the terms of this Agreement.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE WAIVER, INCLUDING MY ACKNOWLEDGMENT OF THE RISK OF INJURIES AND LOSS THAT MAY ARISE OUT OF MY/MY CHILD(REN)'S ENTRY INTO HOLA.