Family Information Parent/Guardian* Relationship* Select relationshipMotherFatherOther Email Address* Mobile Phone* Occupation* Additional Info Spouse Relationship Select relationshipMotherFatherOther Email Address Mobile Phone Home Address Select stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Home Phone Children Information Child #1 Name* Gender* Male Female Date of Birth* School Grade* Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade Any Allergies/Medical Conditions* Child #2 Name Gender Male Female Date of Birth School Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade Any Allergies/Medical Conditions Child #3 Name Gender Male Female Date of Birth School Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade Any Allergies/Medical Conditions Liability & Photo, Media and Copyright Release I/We do hereby waive, release, absolve, forever discharge, and do further agree to indemnify and hold Young Roots, trustees, officers, volunteers, and agents harmless from and all claims, damages, losses and/or expenses arising out of participation in Young Roots activities. I/we assume all liability for any and all personal injury, bodily injury, illness or property damage that occurs as a result of participation in such activities. I/we also agree that we will not bring any lawsuits nor make any demands nor pursue any complaints against Young Roots as a result of his/her participation in Young Roots activities. Agreement to this Release also warrants that participation in this activity is voluntary and we have read and understand the inherent risks involved in the activities. I/We grant Young Roots my/our permission to photograph, videotape, and/or audiotape my child during activities at Young Roots. These photographs/videos/audios will remain the property of YoungRoots and may be used in advertising or marketing campaigns on Young Roots’s websites, and for promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, newspaper articles, Youtube promotions. I/We hereby waive and release on behalf of my child, any rights to compensation for, or ownership of, such images and/or sounds. I have read and agree to the terms and conditions of this Liability and Photo, Media and Copyright release.
