Permission Form - Scottcreek

Consent, Confidentiality and Acknowledgement of Risk

Accidents can result when youth participate in activities and can occur with or without any fault on either the part of the participant, School or its employees or agents, or the facility where the activity is taking place. By allowing my child (the Youth) to participate in the Yo Bro | Yo Girl Youth Initiative (YBYG) Program (Program), I, the Parent/Guardian (s) am (are) accepting the risk of an accident occurring, and agree that the Program, is suitable for my child.

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

1. have read and agree that the Program and activities are appropriate for the Youth and hereby provide consent for the Youth to participate in the activities;
2. have represented to YBYG that the Youth is medically fit to participate in the Program and related activities, and have informed the Youth not to  participate further if he/she/they feel anything to be unsafe;
3. hereby 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 COVID19);
4. hereby give my permission for the Youth to consume drink and food items provided during the Program and related activities;
5. agree that I shall pay any and all financial obligations, loss or claims for compensation that YBYG may suffer or incur in any way as a result of the Youth’s participation in the Program and related activities;
6. hereby waive any and all legal rights that I may have now or in the future and release from liability and agree not to sue YBYG for any loss or damage that I may suffer as a result of the Youth’s participation in the Program and related activities;
7. hereby recognize that releasing YBYG from liability prevents me from claiming for money from YBYG;
8. have discussed with the Youth my expectations, YBYG’s expectations, and the risks and consequences if he/she/they does (do) not follow guidelines stated by the YBYG staff, and that I accept and assume all these risks and the consequences and freely choose to permit the Youth to participate in the Program and related activities regardless;
9. hereby agree that it is my responsibility to arrange insurance to cover any loss or damage the Youth may suffer, or liability that may incur, as a result of the Youth’s participation in the Program and related activities; 
10. understand it is my right to obtain as much information as required about the Program and activities and associated risks and hazards, including information beyond that provided to by the school or program; 
11. 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”);
12. acknowledge that YBYG and Coquitlam School District consents and written communication will be stored and shared between YBYG and Coquitlam School District in an online repository. Once participants such as my child are in the Program, communications will be conducted via phone, other online platforms or in person; 
13. acknowledge that YBYG preserves confidentiality of youth and families except when required by law, continuity of care, or the child’s and family’s safety.

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 CONTACT INFORMATION:
by signing the consent, the parent/guardian agrees to all the policies stated in the permission package