Jóvenes en Acción Enrollment Forms
We are so happy you are going to be a part of Jóvenes en Acción (JEA)! Please complete the following forms to finish your enrollment process. Here are a few things to note:
Each heading indicates whether the section should be completed by youth, parent/guardian, or both.
If you have any other questions about enrolling, please reach out to Rebecca Kamins, our Youth Support Coordinator, at firstname.lastname@example.org.
Release of School Records for (Youth and Parent/Guardian)
As a part of JEA, you will receive free educational support. To help us with this, we ask that you share access to your grades, so we can support you academically. The Release Information is below.
Emergency Contact Information: (Parent/Guardian)
Medical Information (Parent/Guardian)
This section of the JEA enrollment form will ask you to fill out information regarding medical conditions or other important medical information for your child.
Photo/Video Consent and Release Form (Youth and Parent/Guardian)
I hereby give permission for Hyde Square Task Force to use for educational and/or publicity purposes only any photographs, film, or video taken of my child during the course of his or her participation in Hyde Square Task Force programming. I understand that my child and/or any other identifying information may be used in accounts of the Hyde Square Task Force programs, including newspaper and magazine articles, social media, website and other internet materials, television, and other presentations or publications concerning the programs.
I understand and acknowledge that my consent to the use of the above information is purely voluntary and is not required by Hyde Square Task Force as a condition of my child’s participation in Hyde Square Task Force programming. I knowingly and voluntarily release and hold harmless Hyde Square Task Force, its agents and employees from any liability of any kind resulting from use of the information as set forth above. This release and waiver of liability is binding upon my successors, heirs, and assigns.
Release and Waiver of Liability Agreement for Participation (Youth and Parent/Guardian)
This agreement is by and between Hyde Square Task Force and the individual whose name is signed and printed below (herein referred to as participant).
I hereby agree to the following:
1. I am participating in the Jóvenes en Acción Program at Hyde Square Task Force, during which I will participate in physical activity workshops. I recognize that participation in such activities requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Jóvenes en Acción Program. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Jóvenes en Acción Program.
3. In consideration of being permitted to participate in the Jóvenes en Acción Program, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.
4. In further consideration of being permitted to participate in the Jóvenes en Acción Program, I knowingly, voluntarily and expressly waive any claim I may have against Hyde Square Task Force and its employees, board members, officers, volunteers, and staff for damages, and injury, including death, that I may sustain as a result of participating in the Jóvenes en Acción Program.
5. I and my heirs or legal representatives forever release, waive, discharge and covenant not to sue Hyde Square Task Force and its employees, board members, officers, volunteers, and staff for any injury or death caused by my voluntary participation in the Jóvenes en Acción Program.
I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. This agreement remains in effect for as long as I participate in the Jóvenes en Acción Program.
Date Format: MM slash DD slash YYYY