By signing above, 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 Mosaic: Interfaith Youth Action (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
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 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.
