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1. I understand that my membership in the Barry Community Foundation Youth Advisory Council (YAC) is not only an honor but also a responsibility. As a member, I will work toward achieving these goals:
*Identify problems teenagers are facing. Suggest solutions to these problems and work toward solving these problems.
*Provide information about the Youth Advisory Council in my school and other organizations I am involved.
*Increase awareness of youth issues in the community.
*Gain leadership experience.
*Gain friendships and contacts from other area schools.
2. I will be respectful, inclusive, and kind.
3. I will attend and participate in meetings, give my best effort in working on YAC projects, serve on selected committees, and be a spokesperson for YAC.
4. I realize that it is my responsibility to represent youth of Barry County in a positive manner. Should I fail to do this, by incurring disciplinary action in some form (e.g., by law enforcement or school officials), my commitment to YAC may be reevaluated *
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WAIVER & RELEASE OF LIABILITY
Release of Liability & Medical Release
I understand that the Barry Community Foundation Youth Advisory Council program activities may include physical activities and travel (referred to collectively herein as the “Activities”). I affirm that my/my child’s health is good and that I/he/she is not/am not under a physician’s care for any undisclosed condition which might endanger my/his/her health or that of other participants during the Activities. I recognize the inherent risk of injury or disability in the Activities. I agree to assume and accept the risk of physical injury that may result from any of these Activities. I hereby release, indemnify, and hold harmless the Barry Community Foundation, their respective boards of directors and members thereof, affiliates, staff, agents, officers, representatives, volunteers, heirs, successors and assigns (“Releasees”) from any and all claims, liability, or damages for any injury to me resulting directly or indirectly from participation in, and travel to or from, the Activities.
If Participant is under age 18, I as the undersigned parent or legal guardian, for myself and on behalf of my heirs, assigns, and next of kin, hereby release, indemnify, and hold harmless the Releasees from any and all claims, liability, or damages for any injury to Participant resulting directly or indirectly from participation in, or travel to or from, the Activities, to the fullest extent permitted by law.
I further hereby give permission to the Barry Community Foundation to secure emergency medical and surgical care and treatment for the above-named Participant while in attendance at any Activities. I transfer and assign to any hospital or clinic in which the Participant is confined or treated, all hospitalization and insurance proceeds that may be paid by me. I further agree and promise to pay any amount not covered by insurance.
I agree to the release of liability & medical release. (If you are under 18 you will need your parent or guardian's approval.) *
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PHOTOGRAPH USE AND RELEASE
I hereby grant and authorize the Barry Community Foundation and Youth Advisory Council, and persons acting for or through them, the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of the above-named Participant in connection with the Youth Advisory Council, and authorize the Barry Community Foundation, their assigns, and transferees to copyright, use and publish the same in print and/or electronically. I agree that the Barry Community Foundation may use such photographs of Participant with or without Participant’s name and for any lawful purpose, including, for example, publicity, advertising, annual reports, and web content.
I agree to the photograph use and release (If you are under 18 you will need your parent or guardian's approval.) *
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I understand this is a legal representation of my signature.
Clear
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I understand this is a legal representation of my signature.
Clear
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