Liability and Media Release Form – Guyanese Girls Rock Foundation

Liability and Media Release Form

Student Name

First

Last

Please acknowledge the following statements by checking each box.

YWLA Zoom:

I give my child, identified above, permission to participate in the Guyanese Girls Rock Foundation (hereinafter referred to as GGRF), Young Women Leadership Academy (hereinafter referred to as YWLA), to be held on a hybrid schedule online via Zoom and in-person at Queens Central Library.

Code of Conduct:

I agree to have my child follow the YWLA program code of conduct and understand that any violation on my child's part may result in suspension and/or termination from the program.

GGRF Liabilities:

In consideration of the opportunity afforded my child to participate in activities at GGRF, I hereby agree that I, my child, my assignees, heirs, guardians, and legal representatives, will not make a claim against GGRF, or their employees or agents collectively or individually, or any of their volunteers, or the supplier of any materials or equipment that is used by GGRF, for the injury or death to me or my child or damage to our property, however caused, arising from his or her participation in activities at the GGRF.

GGRF Media Release:

I agree to allow Guyanese Girls Rock Foundation, Inc to use any photographic image or name of my child taken while participating in the program. These images may be used in promotions or other related marketing materials, including on our website and social media accounts.

Signature

Parent Name:

First

Last

Today's Date:

Phone:

Email Address:

Parent Electronic Signature:

Clear Signature

By signing and submitting this Application, I certify that the above information is correct and complete. Please use your mouse (or finger on mobile devices) to create signature.