By signing below, I, the undersigned parent/legal guardian of the above youth participant (the “Youth”) grant express permission for the Youth to participate in a children’s program (the “Program”) operated by Kids4Peace Boston (the "Organization”). I understand that in this form the Organization includes the staff, board members, and volunteers. Program activities may include, but are not necessarily limited to: - In-person and online community and team-building activities, educational activities, guest speakers, discussions and dialogues, overnight programs, project-based learning, mentoring, service projects, and other action activities such as advocacy, letter writing, lobbying, etc. - Site visits such as to houses of worship to observe religious services and rituals, to host events with youth in other communities, or activities such as bowling, beach day, mini-golf, etc. - At home activities: the participant may be invited to undertake activities on their own time, such as, but not limited to, online research, meeting with community leaders, project planning, advocacy, letter writing, lobbying, service projects, etc. Please type your full name, which will act as your electronic signature
I further understand that it is my responsibility to arrange for adequate transportation for my Youth at the conclusion of in-person programs and to adequately communicate post-program transportation plans to both my Youth and to the Organization staff. In addition, I understand that if I give my Youth permission to take public transportation and/or ridesharing services (such as Lyft or Uber) at the conclusion of programs that I am responsible for all costs and risks. I agree that the Organization is not liable or responsible during any post-program transportation, including in cases in which the Organization helps to establish carpools between families. . Please type your full name, which will act as your electronic signature
While the Organization takes every precaution (both for physical and socio-emotional safety) before, during, and after all programming, the Youth’s participation in the Program, including each of the activities offered as part of the Program involves a level of risk. By signing below, I understand that the Youth’s activities in the Program have inherent risks that may arise from the activities themselves, my Youth’s own actions or inactions, the actions or inactions of the Organization, its directors, officers, employees and agents, volunteers, and others present at the program, transportation to and from Program sites, and dangers and conditions at Program sites or during virtual programming. I assume full responsibility for any and all risks of bodily injury, death or property damage caused by or arising directly or indirectly from my Youth’s presence at Program sites or participation in the Program virtually or in-person, regardless of the cause. All risks cannot be listed on this form but may include, data mining, phishing, viruses, malware, data breach of online information, cyberbullying, exploitation, victimization, cyber stalking, online grooming, cyber predators...etc. for online programming. Many of these risks are inherent in any use of the Internet. Any additional risk of damage to equipment including but not limited to smartphone, computers, etc. is the sole responsibility of the owner of said equipment. In person risks may include physical injury, bullying, victimization, etc., as such risks are inherent in in-person programming. Please type your full name, which will act as your electronic signature
In consideration for my Youth’s participation in the Program, I waive and release any and all claims against the Organization, its directors, officers, agents, employees, volunteers, and affiliates (collectively, the “Organization Parties”), for any liability, loss, damages, claims, expenses and attorneys’ fees resulting from death or injury to the Youth or property, caused by or arising directly or indirectly from the Youth’s presence at Program sites or participation in the Program, regardless of the cause and even if caused by negligence, whether passive or active. I agree not to sue any of the Organization’s Parties on the basis of these waived and released claims. . Please type your full name, which will act as your electronic signature
I will defend, indemnify, and hold the Organization Parties harmless from and against any and all liabilities, losses, damages, claims and attorney’s fees that may be suffered by any Organization Party resulting directly or indirectly from my Youth’s presence at Program sites or participation in the Program, except and only to the extent the liability is caused by the gross negligence or willful misconduct of the relevant Organization Party. . Please type your full name, which will act as your electronic signature
I authorize the Organization to provide to my Youth first aid and administer medication or seek medical attention for the Youth if an emergency arises. In addition, I waive and release any claims against the Organization Parties arising out of any first aid, treatment or medical service, including the lack or timing of such, made in connection with my Youth’s activities in the Program. Please type your full name, which will act as your electronic signature
1) I, the undersigned parent/legal guardian of the above youth participant (the “Participant”) hereby acknowledge that I understand that I have been offered to have the Participant participate in a children’s online program (the “Program”) operated by Kids4Peace Boston (the "Organization”). I understand that in this Form the Organization includes the staff, board members, and volunteers.
2) Activities and Risks
ACTIVITIES:
Program activities may include, but are not necessarily limited to:
- Online community and team-building activities, both live and pre-recorded, using internet platforms approved by the Organization.
- Viewing of online content including instructional videos and slides.
- At home activities: the participant may be invited to undertake activities on their own time, such as, but not limited to, online research, meeting with community leaders, project planning, advocacy, letter writing, lobbying, service projects that can be safely done during COVID-19.
RISKS:
While the Organization takes every security precaution before, during, and after all online programming, the Participant’s participation in the Program, including each of the activities offered as part of the Program involves a level of risk. All risks cannot be listed on this form but may include, data mining, phishing, viruses, malware, data breach of online information, cyberbullying, exploitation, victimization, cyber stalking, online grooming, cyber predators...etc.. Many of these risks are inherent in any use of the Internet. Any additional risk of damage to equipment including but not limited to smartphone, computers, etc. is the sole responsibility of the owner of said equipment. Participation in the Program is at the Participant’s own risk.
3) PARENT/GUARDIAN CONSENT and WAIVER: I consent to the Participant’s participation in the Program with the knowledge of the risks involved. I accept any and all risks, including the risk of injury or death and/or damage to or loss of property associated with the Participant’s participation in the Program. I hereby agree to waive any and all liability of the Organization, and agree that I will completely indemnify and hold harmless the staff, board, and volunteers of the Organization from any legal action, including any class actions, associated with injury to my child or injuries to property, except in the case of gross negligence.
4) CONTACT SHARING PERMISSION: I the undersigned give permission for the Organization staff to share my contact information and my child's contact information (phone number and email address) with other Organization participants and parents/guardians for the purposes of helping Organization participants connect with one another and work collaboratively.
5) MEDIA RELEASE: I the undersigned give our permission for, and acknowledge the right of the Organization staff and hired and/or volunteer staff to photograph, videotape, audiotape and otherwise record ourselves and my child or children during all Program activities, and to use this and all other documentary material at the discretion of the Organization staff for documentation, publication and promotion (online and in print) according to the Kids4Peace Boston Media and Publicity Guidelines. I waive all my own rights and claims, if any such exist, to the above photographic, videotape or audiotape or any other form of documentary material obtained for or produced by the Organization for the purposes of Organization programs.
In case of an emergency, list the first person to contact:
Please provide the Emergency Contact's Phone Number:
I the undersigned give permission for the Organization staff to share my contact information and my child's contact information (phone number and email address) with other Organization participants and parents/guardians for the purposes of helping Organization participants connect with one another and work collaboratively. Please type your full name, which will act as your electronic signature
I consent to the use by Organization of my Youth’s image, voice, name and/or story in any format, including video, print, or electronic (collectively, the “Materials”), as the Organization may deem appropriate to promote its programs. Organization may make the Materials available at its discretion to third parties, on Organization’s website, in Organization’s publications, or through any other media, including social networking websites. I waive any right to inspect or approve the finished product or to receive any payment. I grant to Organization all copyrights in the Materials and waive any legal claims, including those relating to copyright, or rights of publicity or privacy.. I understand that the full name of my Youth will not be identified in any such photos/recordings.
We occasionally have reporters from news media cover K4PB programs. If an invited reporter would like to print a photo or quote from your child, please check below to give permission
The following acknowledgement and release for one of our host locations must be signed. Your signed acknowledgement and address will be provided to The Epiphany School staff. "I, the undersigned, agree not to hold The Epiphany School or its directors, officers or staff members liable by any reason of personal injury or damage or loss of property suffered in connection with the use of its grounds, or any buildings or equipment or facilities, and further agree to indemnify and hold harmless The Epiphany School, its directors, officers or staff members against any claim arising out of such injury, damage, or loss.
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