Family Information

Parent/Guardian*

Relationship*

Email Address*

Mobile Phone*

Occupation*

Additional Info

Spouse

Relationship

Email Address

Mobile Phone

Home Address

Home Phone

Children Information

Child #1 Name*

Gender*

 Male Female

Date of Birth*

School Grade*

Any Allergies/Medical Conditions*

Child #2 Name

Gender

 Male Female

Date of Birth

School Grade

Any Allergies/Medical Conditions

Child #3 Name

Gender

 Male Female

Date of Birth

School 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.