Permission Form - Annieville

CONSENT, CONFIDENTIALITY and ACKNOWLEDGEMENT OF RISK

Accidents or illness can result when children or youth participate in activities and can occur with or without any fault on either the part of the participant (the student, child or youth), the school district or its employees or agents, or contracted service providers (such as the Yo Bro | Yo Girl Youth Initiative staff), or the facility where the activity is taking place. By allowing my child to participate in the Yo Bro | Yo Girl Youth Initiative (YBYG) program, I, the PARENT/GUARDIAN (s) am accepting the risk of an accident occurring, and agree that this program, is suitable for my child. I, the PARENT/GUARDIAN (s) recognize that some examples of risks to my child include risk of physical injury or acquiring an illness such as COVID-19, among other risks.

By signing the Consent, I, the PARENT/GUARDIAN confirm that I:

1. I, the PARENT/GUARDIAN (s) read and understand the materials provided by YBYG, outlining the YBYG Program and initiatives and agree the activities are appropriate for my child and have provided consent for my child to participate in the activities;
2. I, the PARENT/GUARDIAN (s) represent to YBYG that my child is medically fit to participate in the activities, and have informed my child not to participate further if he/she/they feel anything to be unsafe;
3. I, the PARENT/GUARDIAN (s) agree that I shall pay any and all financial obligations, loss or claims for compensation that YBYG or Delta School District may suffer or incur in any way as a result of my child’s participation in the activities;
4. I, the PARENT/GUARDIAN (s) waive any and all legal rights that may exist now or in the future and release from liability and agree not to sue YBYG or the Delta School District for any loss or damage that it may suffer as a result of my child’s participation in the YBYG Program;
5. I, the PARENT/GUARDIAN (s) recognize releasing YBYG and the Delta School District from liability prevents me from claiming for money from YBYG or the Delta School District;
6. I, the PARENT/GUARDIAN (s) represent that I have discussed with my child my expectations, as well as YBYG and the Delta School District’s expectations, and the risks and consequences if he/she/they does not follow guidelines stated by the YBYG mentor or school district personnel;
7. I, the PARENT/GUARDIAN (s) accept and assume all of these risks and the consequences and freely choose to permit my child to participate in the YBYG program activities regardless;
8. I, the PARENT/GUARDIAN (s) agree that it is my responsibility to arrange insurance to cover any loss or damage my child may suffer, or liability that may incur, as a result of my child’s participation in the YBYG program;
9. I, the PARENT/GUARDIAN (s) understand that it is my right to obtain as much information as required about this program or activity and associated risks and hazards, including information beyond that provided to by the school or program;
10. I, the PARENT/GUARDIAN(S) recognize that YBYG may wish to promote my child’s positive interactions, accomplishments, photographs, and video on YBYG’s media, including without limitation, the YBYG website, emails, social media, and printed or digital promotional materials (“YBYG Media”);
11. I, the PARENT/GUARDIAN (s) acknowledge that YBYG and Delta School District consents and written communication will be stored and shared between YBYG and Delta School District in an online repository, and once participants such as my child are in the YBYG program, communications will be conducted via phone, other online platforms or in person;
12. I, the PARENT/GUARDIAN (s) acknowledge that YBYG preserves confidentiality of children, youth and families except when required by law, continuity of care, or the child’s, youth’s and family’s safety;
13. I the PARENT/GUARDIAN (S) agree that the Youth will not attend the Program or related activities if he/she/they is ill, including, but not limited to, symptoms associated with any respiratory disease (e.g., the common cold, allergies or COVID-19;
14. I the PARENT/GUARDIAN (S) agree give my permission for the Youth to consume drink and food items provided during the Program and related activities;
15. I, the PARENT/GUARDIAN (S) agree that I or my designate (authorized pick-up person) will pick my child up after the program or provide written authorization that my child may go home unaccompanied.

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I hereby give {name-1} {name-2} permission to participate in the Program and related activities and accept the level of supervision for the Program.

PARENT/GUARDIAN

by signing the consent, the student/parent/guardian agrees to all the policies stated in the permission package.

PARTICIPANT:  In consideration of Yo Bro | Yo Girl (YBYG) Youth Initiative permitting me to participate in YBYG activities, I, {name-1} {name-2}, have discussed this with my parent(s)/guardian(s) and agree to abide by the YBYG policies and follow directions given to me by YBYG Program supervisors and mentors. 

REGISTRATION CONTRACT

I, {name-1} {name-2}, understand that my acceptance and retention in the Yo Bro | Yo Girl program is dependent on the following conditions:

1. That participation and cooperation is required during all activities including field trips, P.E., and all program events (except for sound medical reasons).
2. Student must be willing to meet with staff when requested to discuss any concerns.
3. Expulsion from the program may result for any of the following reasons:
   • destruction of any of the facilities or equipment (including theft),
   • drugs or alcohol taken to the school or to any school function,
   • under the influence of either drugs or alcohol while at school or any school function,
   • carrying weapons,
   • physical fighting,
   • bullying
4. The following behaviours are not permitted during the program:
   • inappropriate/abusive language to staff and/or fellow students,
   • gossiping, disrespect to staff, skipping classes,
5. Use of laser pointers is prohibited.
6. Cell phones and pagers must be turned off during class.
7. There is to be no visiting by other students from other schools during hours of
8. Students are expected to have respect for school property. This includes general cleanliness of classrooms, washrooms and
9. Students shall not wear clothing that is inappropriate to the learning environment such as clothing that advertises or advocates drug, alcohol abuse or violence.

STUDENT ACCEPTABLE (RESPONSIBLE) USE OF TECHNOLOGY POLICY

1. I will keep my username and password to myself.
2. I will be respectful of myself and others when using technology.
3. I will not view, download, or upload anything that is illegal, inappropriate, or that may cause harm or distress to others.
4. I will not take photographs or video of other students without their permission, nor will I post pictures of others without their permission.
5. I understand that school systems and devices are primarily intended for educational purposes.
6. I will respect others’ work and property and will not access, copy, remove or otherwise alter any other person’s files or information without their knowledge and permission.
7. I understand that if I use my personal devices at school, I must follow the rules set out by this Acceptable (Responsible) Use of Technology policy and my teacher’s instructions.
8. I will immediately report any damage of devices or software, cyberbullying, inappropriate content, and other concerns to my teacher.
9. I understand that I am responsible for my actions when using technology both inside and outside of school.
10. I understand that the school will take appropriate action if I don’t follow the rules.

I have read and understand the rules for using technology. 

Student Name: {name-1} {name-2}