I/we, the undersigned, individual and as parent(s) and or legal guardian(s) of THE YOUTH LISTED ON THIS FORM, a minor, give permission to participate in the youth program. In consideration of this participation, I/we do hereby agree to release, discharge, and hold harmless Sacramento Youth Center & its partner organizations , 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 activities.
I 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/we give permission to attend the Sacramento Youth Center. I understand the YAB involves recreational activities, and I acknowledge that reasonable measures will be taken to safeguard the health and safety of all participants. In case of a medical emergency, I hereby authorize calling a physician at my expense to provide whatever medical or surgical treatment is necessary. I understand I will be notified as soon as possible in case of any emergency affecting my child. I confirm the information I have provided on these forms is complete and correct as far as I am aware, and give permission to staff and adult volunteers as noted.

I agree to indemnify and hold harmless SYC, its officers, agents and employees from any and all claims, damages, expenses, or injuries arising out of or incident to my child’s participation in this project, unless such loss or injury results directly from the neglect or willful act of an officer, agent, or employee of Sacramento Youth Center acting within the scope of their employment.

I/we grant permission to Sacramento Youth Center, 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.

I, the parent or legal guardian, hereby give my permission for my child(ren) to participate in virtual/online programming.
BY SIGNING BELOW I AM CONSENTING TO STATEMENTS ABOVE.

All data obtained from your child will be kept confidential and will be used by staff to increase the quality of the program. However, data will be shared with all program partners. Survey forms completed by your child will not include identifying information and data gleaned from them will only be reported when included in combined group results only. Individual data may be used to support program staff become more aware of the unique strengths and challenges of your child, allowing them to tailor and improve the program to meet their specific needs. The data collected will be stored in a HIPPA-compliant online server. Participation in this evaluation is completely voluntary. You have the right to withdraw your child from the evaluation at anytime or refuse to participate entirely without jeopardy to your status in the program. If you desire to withdraw, please contact Adam Shipp. If you have any questions about program evaluation, you may contact Adam Shipp at 925-550-9673. I have read and understand this consent form and I agree to allow my child to participate in this study.

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 (The Youth) 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
-Medical Release
- Program Evaluation & Confidentiality
- Youth Program Code of Conduct