Participant Information

I hereby give my permission for my child(ren) as listed in this form to participate in Southland Integrated Services Inc.’s Youth Summer Program. I understand that the workshops are centered around Mental Health and related topics and my child will be participating in various hands-on activities. This event is free to the public and I understand that my child’s attendance is voluntary. By attending this event, I understand I will not be compensated from any party for my child’s attendance. 
 
I understand that there is a potential for injury and I hereby agree to release Southland Integrated Services, Inc. from any legal responsibility from my child’s participation. I understand that I will need to give consent for my child’s photo and video to be taken through photo consent form. I understand that I will arrange for drop off and pick up of my child(ren) from 2:30-4:30 PM for the Youth Summer Program.
 
Furthermore, whomever will be picking up the child, will need to have a valid photo ID and verification. I understand that my photo ID will be scanned for the verification process.  
 
By signing this form, I confirm understanding all items of this consent form. 

I consent for photographs and/or video images to be taken of my child(ren) by Southland Integrated Services, Inc. or a representative. I understand the images will be for programmatic and marketing purposes (website, print, digital or social media).

By consenting to photographs and/or video images I understand I will not be compensated from any party. Although photographs and/or video images will be used without identifying information such as name, I understand it is possible someone may recognize me.

I further acknowledge that my participation is voluntary and agree that use of any photographs and/or video images confers no rights of ownership.

I hereby release Southland Integrated Services Inc., its employees, and any third parties involved in the creation of or publication of educational or marketing materials, from liability for any claims by me or any third party in connection with my participation.

By signing this form, I confirm understanding of this consent. If I wish to withdraw my consent in the future, I may do so via written request submitted to Southland Integrated Services, Inc. or by completion of a new form.