Eligibility Form

I/we, the undersigned, individual and as parent(s) and or legal guardian(s) of the student listed above, a
minor, give permission to participate in #SacYouthWorks: Futures. In consideration of this participation,
I/we do hereby agree to release, discharge, and hold harmless Partner Organization, PRO Youth &
Families, the City of Sacramento, and the California Board of State and Community Corrections,
its trustees, officers, agents, and employees of and from all causes, liabilities, damages, claims, or
demands whatsoever on account of any injury or accident involving the said minor arising out of my child’s
participation in the program/project activitiesI understand that participation in this program does NOT guarantee a stipend and this is not a paid position.
BY SIGNING BELOW I AM CONSENTING TO STATEMENTS ABOVE.

I grant permission to Partner Organization , PRO Youth & Families, the
City of Sacramento, and the California Board of State and Community Corrections, and/or its agents or
employees to use photographs and/or video taken of my child during this program for use in promotional
and educational materials and to use such photographs/video in electronic versions of the same
publications or on organization sites or other electronic forms of media, and to offer them for use or
distribution in other media outlets, electronic or otherwise, without notifying me. I hereby agree to release,
defend, and hold harmless and its agents or employees, including any firm publishing and/or distributing
the finished product in whole or in part, whether on paper, via electronic media, or on Web sites, from and
against any claims, damages, or liability arising from or related to the use of the photographs/video.BY SIGNING BELOW I AM CONSENTING TO STATEMENTS ABOVE.


The primary purpose of the Youth Program Code of Conduct is to ensure the safety and well-being of all participants in the program. As a participant in this program, youth will be asked to abide by the following guidelines:

Conduct themselves in a courteous manner and treat members, parents, volunteers, staff, and others with respect. Appropriate language and behavior are expected at all times.

Respect and adhere to the rules and guidelines of the program including all those specific to this project.

Uphold an individual’s right to dignity by supporting an environment of inclusion which welcomes involvement of participants from all backgrounds.

Obey local, state, and federal laws.

Participants who fail to adhere to the Youth Program Code of Conduct are subject to dismissal from the program.

I/we understand the code of conduct that will be expected of all program participants.

I have read and checked the terms listed above:
- Parental/Guardian Permission and Liability Release
- Media Release
- Program Evaluation & Confidentiality
- COVID-19 Terms
- Youth Program Code of Conduct


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