YMCA Resource Fair Registration Form

• I will sign in and check in with staff upon arriving to the event and will participate in all aspects of program until dismissed.
• I will come ready to work and will bring appropriate materials with me when participating.
• I will receive permission from staff if I need to leave the program space (restroom, lockers, etc.).
• I will demonstrate respect for all persons, property, and the environment.
• I will respect the personal space and belongings of other students and staff.
• I will respect the program space and will clean up after myself.
• I will treat all program staff and volunteers with respect and will adhere to their direction.
• I will avoid inappropriate conversations and language (i.e., cursing, swearing, racial remarks), and/or any form of verbal abuse, negative sign or body language, gossip and/or sarcasm.
• I will respect the University YMCA and adhere to the rules and expectations set forth by the YMCA’s leadership.
• I will not use my cellphone or any other electronic devices during workshops.  I understand that if I don’t adhere to this rule, I will be asked to leave the event.
• I have read the above mentioned program guidelines and understand that if I do not comply with them, I may be asked to leave the event for the day early.

I understand that transportation to and from this event will not be provided by the YMCA and that it is my responsiblity to make arrangements for my child to get home safely from this event. 

As the parent/legal guardian, I give full authorization to the YMCA of Pierce and Kitsap Counties staff or designated adult leaders to secure medical care or treatment for the participant named on this form.

In the event that my student is injured, I give YMCA first-aid and CPR-certified staff authority to provide basic first-aid and CPR as the situation requires, including splinter removal, as necessary and/or if my student becomes seriously ill or injured and I cannot be reached.

I grant my permission for any medications that I approved listed on the front side of this form, to be administered to my student for common ailments.

I understand that this treatment may include assistance from the nearest physician, medical clinic, hospital, trained nurse or EMT in the event of illness or injury that reuqires immediate attention, as determined by the YMCA staff.

In the event the participant as named above is injured or becomes seriously ill and I cannot be reached, I authorize any and all hospitalization, medical, dental and/or surgical treatment advisable by the circumstances.

I understand that as a parent/legal guardian, it is my responsibility to provide my own accident and health insurance while participating in all YMCA activities, and the YMCA does not provide any health or accident coverage for its participants.

I understand that some activities may require travel outside of the city/county limits, State of Washington, and/or across international borders and will be notified by a permission slip or additional program information prior to said event(s).

I understand that this completed health form will be kept on file until my student graduates or is no longer involved in any YMCA Teen Leadership Development program and may be photocopied for trips or Teen Leadership Development programs taking place in other YMCA of Pierce and Kitsap Counties centers.

I acknowledge that both sides of this form are correct and complete and the person herein described has permission to engage in any/all registered Teen Leadership Development programs.

I am aware that participation in YMCA programs and use of YMCA facilities may involve certain hazards associated with equipment, physical exertion, games, sports, and other programs/activities offered by the YMCA. In consideration of, and as part payment for, the right to use YMCA facilities and participate in YMCA programs, I hold harmless, waive, and release the YMCA ("YMCA" includes its employees, volunteers, directors, officers, and agents) for damages of any type, including permanent physical injuries or death, arising out of the ordinary negliglence of the YMCA and also for damages of any type arising out of my own negligence, in whole or in part.

By participating in the YMCA and its program, I agree to release the National Council of Young Men's Christian Associations of the United States of America, and its independent and autonomous member associations in the United States and Puerto Rico, from claims of negligence for bodily injury of death in connection with the use of YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law.

I assume all risk of injuries and damages associated with my participation in YMCA programs and the use of YMCA facilities including, but not limited to, falls, slips (whether occuring while in the building, offsite as a part of a program, or anywhere else on the YMCA facilities or property, including adjacent sidewalks, access, and parking areas), contact with other participants, sudden and unforeseen malfunctioning of any equipment, instruction, training, supervision, massage, therapy, classes, or dietary recommendations, the effects of the weather and/or temperature indoor or outdoor, and all other such risks being known and appreciated by me.

For participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), 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/my child; sound track recordings of me/my child; photo reproductions of me/my child; any narrative account of my/my child's experience.

My consent includes a perpetual license to the Y 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 the Y 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 product of services.

With respect to any of the above uses, I further agree: All works shall belong to the YMCA of the USA. The Y has no duty of confidentiality regarding any licensed uses. YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world. The Y and collaborating third-parties may use any video film, footage, sound track recordings and photo reproductions of me/my child or my narrative account for any purpose without additional compensation to me.

I agree that my consent is irrevocable. I hereby release and discharge The Y 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.