C.O.P.E.S. Registration

Healing is a voluntary process, and the minor participant, their parent or legal guardian may decline or withdraw from C.O.P.E.S at any time. Engaging in a journey of healing in Missouri carries certain potential risks, and by signing this form, you acknowledge and accept these risks on behalf of yourself and the minor participant. While healing is often helpful, it may involve discussing unpleasant aspects of the minor's life, which can sometimes result in an initial increase in uncomfortable feelings like sadness, anxiety, anger, or frustration. In C.O.P.E.S, confidentiality is protected by law but has exceptions, such as if our team has reason to believe a child is being abused or neglected, or if the minor makes a serious threat to harm themselves or others. In these cases, the team is legally required to report to the proper authorities.

This document also acknowledges that healing is a collaborative process and that the parents or legal guardians, along with the minor(s), will be involved. Parents or guardians may be invited to sessions with the minor to facilitate the healing process. By signing below, you affirm that you have read and understand these potential risks and that participation in C.O.P.E.S is voluntary.

As the parent/legal guardian of the minor participant, I hereby acknowledge and understand that the activity known as [C.O.P.E.S ] involves potential risks. I voluntarily assume all such risks on behalf of myself and my minor child. I agree to release, discharge, and hold harmless [C.F.C], its officers, employees, and agents from all claims, demands, or causes of action for any risks to my minor child or myself arising from or related to the activity. This includes potential claims and damages resulting from the negligence of [C.F.C]. I intend for this waiver and release to be a complete and unconditional release of all liability to the greatest extent allowed by Missouri law.

As the parent and/or legal guardian of the minor identified below (the "Minor"), I hereby agree to indemnify, defend, and hold harmless [The Michael Brown Sr. Chosen for Change Organization], its officers, directors, employees, volunteers, and agents (collectively, "the Released Parties") from and against any and all claims, demands, liabilities, damages, causes of action, or expenses (including reasonable attorneys' fees) of any kind arising out of, or in any way connected with, the Minor's participation in the [C.O.P.E.S].

This obligation to indemnify, defend, and hold harmless is specifically intended to include claims that are caused, or alleged to be caused, in whole or in part, by the negligence (active or passive) of any of the Released Parties. I understand and agree that this provision obligates me to financially protect the Released Parties from legal action and associated costs, even if the claim is related to their own negligent conduct. I further agree that I will not sue or make a claim against the Released Parties for any injuries or damages that may arise from the Minor's participation.

Parent/Legal Guardian Certification and Consent

I, the undersigned, certify that I am the parent or legal guardian of the minor participant named above.

I hereby grant permission for my minor child to participate in the [C.O.P.E.S.]. I understand and acknowledge that participation may involve potential risks.

I accept responsibility for all risks associated with my child's participation and release, waive, and discharge [C.F.C], its officers, employees, volunteers, agents, and other representatives from all liability, claims, or demands arising from any injury or illness resulting from my child's participation

Authorization for Emergency Medical Treatment

In the event of an injury, illness, or medical emergency, and if I, the parent/guardian, cannot be reached after a reasonable effort, I hereby authorize the following:

1.) Any adult supervisor, volunteer, or event staff to summon and authorize any and all professional emergency personnel to attend, transport, and treat my minor child.

2.) Any licensed physician, surgeon, or other medical professional to provide any X ray, anesthetic, medical or surgical diagnosis, treatment, and hospital care deemed advisable for my child's health and safety.

I understand that this authorization is given in advance and is intended to provide the necessary authority for the supervising adult to act in my child's best interests in an emergency.

Acknowledgment of Financial Responsibility

I understand and agree to assume full financial responsibility for any and all costs arising from any medical care, treatment, or hospital services rendered to my minor child during their participation in the activity. This includes any costs not covered by my health insurance.

Parental Consent and Media Release Form

This form allows [The Michael Brown Sr. Chosen For Change Organization] to obtain permission from a parent or legal guardian to photograph or film their minor child during [C.O.P.E.S] for promotional purposes. These media materials will be used to promote our organization and its mission.

I, the undersigned parent or legal guardian of the minor participant named above, hereby grant [Organization's Name], and its agents and employees, the irrevocable and unrestricted right to photograph, film, and/or record my child. I authorize the use of these images, videos, and/or audio recordings for any lawful purpose, including but not
limited to:

● Promotional materials (e.g., flyers, brochures, posters)
● Online platforms (e.g., website, social media, email newsletters)
● Advertising and public relations
● Educational or training material

I understand and agree to the following conditions:

● Rights and Ownership: All media captured and produced will be the sole property of [C.F.C]. I waive any right to inspect or approve the finished product and any advertising copy that may be used.

● No Compensation: I will not receive any financial compensation for the use of my child's image, likeness, or voice.

● Liability Release: I hereby release and hold harmless [C.F.C] and its
representatives from any claims, demands, or liabilities whatsoever arising from or in connection with the use of these materials. This includes, but is not limited to, claims of libel, invasion of privacy, or infringement of any rights.

● Identification: My child's full name will not be published alongside their image unless specific, additional permission is granted. The organization may use my child's first name, or a fictitious name, for identification purposes.

● Indefinite Use: The organization may use the photographs and videos
indefinitely unless I provide a written request to withdraw consent.

By signing this form, I affirm that I am the parent or legal guardian of the minor participant named above and have the legal authority to sign this release.

Governing Law and Severability

"Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Missouri, without regard to its conflict of laws principles. Severability. If any provision of this Agreement is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall remain in full force and effect and shall not be affected or impaired in any way, unless the invalid provision is essential to the purpose of the Agreement.

Acknowledgment and Signature

Statement of Understanding: I, the undersigned parent or legal guardian, certify that I am at least 18 years of age and am fully competent to sign this Release on behalf of the minor participant named herein. I have read this document in its entirety, understand all of its terms, and I voluntarily consent to my child's participation in the specified activities.

By signing below, I agree to be bound by the waiver and release of liability contained within this document. I acknowledge that I am giving up certain legal rights or remedies that might otherwise be available to me and the minor participant