Waiver | Worldwide 2023 "*" indicates required fields Who will be signing?* I am over 18 and will be signing for myself. I am the parent/legal guardian for this youth and will be signing on their behalf. Parent/Adult InformationName* Email* Phone*Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attendee InformationYouth email will be used for camp preparation emails. Attendee Information*First and Last NameEmailPhoneBirth DateSex Add RemoveUse the "+" icon to add attendees. Attendee Medical/Mental Notes* Yes, I would like to add notes for one or more attendees. No, I would not like to add any notes. Medical/Mental Notes*Attendee NameNotes Add RemoveUse the "+" icon to add notes for additional attendees.Attendee Dietary Needs/Requests* Yes, I would like to No, I would not like to Dietary Requests*Attendee NameNotes Add RemoveUse the "+" icon to add notes for additional attendees.Emergency Contact?* Parent/Gaurdian will be emergency contact I wish to add another emergency contact Pickup Authorization* I will be picking up my youth. I would like to add one or more authorized adults to pick up my youth. Emergency Contact InformationContact Name* Contact Phone*Emergency Contact's Relationship to Attendee* Pickup AuthorizationThe following adults (18 years or older) are authorized to pick- up this child, should the above named parent be unable to do so: Note: A photo ID will be required before the camper is released into the custody of an adult other than the parent(s) who dropped the camper off.Authorized Persons*NameRelationship to Youth Add RemoveUse the "+" icon to add more authorized persons. WaiverAcknowledgment of Risk, Waiver of Liability, and Consent for Treatment:*ACKNOWLEDGMENT OF RISK I, the undersigned adult, acknowledge that participating in any Youth for Freedom event is a voluntary activity that involves risks that are inherent in group activities. Risks include, but are not limited to, injury or death arising from: participation in sports activities; waterfront activities, adventure activities, children’s failure to follow instructions of counselors and supervisors; communicable illness; and independent acts of third parties not under the control of counselors and supervisors. I acknowledge that all risks cannot be prevented, and assume those beyond the control of the Youth for Freedom staff. Further, I hereby fully and forever waive, release, acquit, hold harmless, and discharge Youth for Freedom from any and all claims, demands, rights, losses, suits, actions and causes of action, obligations, damages, costs, or expenses of any nature relating to injury of any type suffered during or otherwise arising from any children’s program. I further acknowledge that it is my responsibility to share any requests for accommodations. I agreeMedical Release:*MEDICAL RELEASE: I will fill out the medical form for myself or my child. I hereby give permission to Youth for Freedom and its authorized representatives (i.e., staff or volunteers) to provide, seek and consent to routine health care, administration of prescribed medications, and emergency treatment for myself or my child, as may be needed, including but not limited to: x-rays, routine tests and treatment, or hospitalization. I also give permission to Youth for Freedom and its authorized representatives to arrange transportation for myself or the child for said medical treatment or tests. I hereby agree to the disclosure to authorized Youth for Freedom representatives of the protected health information of the camper as necessary: (a) to provide relevant information to Youth for Freedom related to the attendee's ability to participate in camp activities and (b) in the case of minors, to provide relevant information to Youth for Freedom to keep myself, or me as the parent, informed of myself or my child’s health status. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the camper named herein. This form may be photocopied for trips out of camp. I understand that I will be contacted if my child is exposed to a communicable disease or if medical referral is necessary. I agreePublic Health Precautions:*PUBLIC HEALTH PRECAUTIONS I understand that during the Covid-19 public health situation, Youth for Freedom Worldwide, Inc is proceeding with this event with caution and encourages all participants to take actions to keep ourselves and each other as healthy and safe as possible during this time. I understand that it is my responsibility to assess my child for symptoms of any illness, prior to the event. If my child or I have questions or concerns at any time regarding this, they are encouraged to reach out to members of the Youth for Freedom team, for support. I understand that there is no list of restrictions, guidelines or practices that will remove the risk of exposure to COVID-19 or other illness. I understand that I play a role in taking actions to reduce the risk to myself, my child, and to others. I understand that the individuals attending the events may have a wide variety of perceptions of the COVID-19 situation or other illness and history of personal precautions taken, and not taken, during the COVID-19 situation or with other illness. I agreeAudio/Video/Media Release:*Audio/Video/Media Release: I grant permission for audio and video recordings as well as photographs of my child taken at camp to be used for promotional purposes on behalf of Youth for Freedom, LLC. Such promotion may include but is not limited to, the web site, Youth for Freedom social media pages/accounts, or printed materials like brochures, posters, flyers, etc. I understand that my child’s full name will NOT be used in these promotions. I agreeTransportation:*Transportation Transportation Permission: The undersigned does also hereby give permission for their child to ride in any vehicle driven by a specifically approved and licensed adult Youth For Freedom Staff Member while attending and participating in activities sponsored by Youth For Freedom, LLC. My child and I understand that seat belts are required to be worn at all times during transportation. I agree that if my child drives themself to the conference, that the vehicle will be parked in the assigned area for the duration of the conference. (Requirements for Approved Adult Staff Members to drive youth include the following: Minimum 21 years of age, valid, current Driver’s License, clean driving record, and a minimum of 7 years driving experience). I agreeMobile Phones:*Mobile Phones: I understand that YFF allows youth to have cell phones so they can use them for taking pictures, and I agree that calls and text messages are disruptive to the conference. I will not contact my youth via their phone unless it is a major emergency; or I will call the number for the staff to reach them. I give permission for the counselor to take my youth’s cell phone if it is being used inappropriately during the conference. I agreeBehavior Guidelines:*Behavior Guidelines: I (and my youth) have read and understand, and are willing to abide while at this event by the Youth for Freedom Event Guidelines. I agreeParent/Guardian SignatureI have read and understand the nature of the camp and its inherent risks and I knowingly give consent for participation. I acknowledge that I have read and reviewed these items with my attending youth. Signature* Reset signature Signature locked. Reset to sign again Parent/Legal Guardian SignatureDate*Today's Date Month Day Year SignatureI have read and understand the nature of the camp and its inherent risks and I knowingly give consent for participation.. Signature* Reset signature Signature locked. 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