Yo Bro | Yo Girl Youth Initiative

Newton Recreational Center Waiver

Language:

PARENT/GUARDIAN

by signing the consent, the student/parent/guardian agrees to all the policies stated in the Terms and Conditions.

CONTACT INFORMATION:

First Name *

Last Name *

School

Grade

Age

Student Number

Home Address

Please indicate with a check (√) for agreement to the following statements:

Indigenous Status: If yes,First NationsInuitMetisNo

Newcomer Status:Canadian CitizenNewcomer

Preferred Pronoun:He/him/hisShe/her/hersOtherPrefer Not to Say

Gender:MaleFemaleOtherPrefer Not to Say

If you checked "Other" on the Preferred Pronoun and Gender Field, kindly specify here

*Information collected on this form is strictly confidential and is for Surrey/YBYG Office Use Only

I hereby give:

permission to participate in the Program and related activities and accept the level of supervision for the Program.

Please indicate with a check for agreement to the following statements:I consent to the publication of photographs, video, and name of my child on YBYG Media as described above.There are no known food allergies or medical conditions (except as noted below).

Allergies/Medical Conditions:

Signature of parent if student authorized to go home unaccompanied

PARENT/GUARDIAN

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

Parent/Guardian Name *

Parent/Guardian Signature *

Start signing your signature here

Date Signed *

Parent/Guardian Email Address

Parent/Guardian Phone Number

Registered Charity Number: 82510 4649 RR0001

We acknowledge that YBYG operates on the traditional, ancestral, and unceded territories of Indigenous Peoples across British Columbia. We are committed to building respectful relationships and supporting Indigenous youth in the communities we serve.

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