YAC Oregon Youth Summit 2/2/24

Friday, February 10, 2023
8:00am-3:30pm

YAC members will travel with Rich Mueller, Parks Planning Manager, via City vehicle to Salem for the 2024 Oregon Youth Summit. Lunch will be provided. We will meet at/return to the Van Raden Center.

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GENERAL INFORMATION

First Name *

Last Name *

Parent Name(s) *

TERMS OF ACCEPTANCE AND SIGNATURE

Please have your parent or guardian read and accept these terms.

Terms of Acceptance

Waiver of Liability, Photo/Video Release, Medical Release, and Parent Permission
Please read carefully and be aware that by your participation in this program/activity, you are expressly assuming risk and legal liability and waiving and releasing all claims for injuries.

Waiver of Liability
I recognize and acknowledge that there are certain risks of physical injury and property by participating in this program. I agree to assume the full risk of any injuries, including loss of life, personal injuries, property damages, and expenses, which I may sustain as a result of participating in any and all activities connected with or associated with the City of Tualatin Program. I also hereby waive, release, indemnify, hold harmless, defend, convenant not to sue, acquit, and forever discharge, the City of Tualatin and all officials, employees, officers, and agents of the City of Tualatin, from and against any and all rights of action, claims, demands, liabilities, injury, losses, or damages of any kind, arising in whole or in part out of my participation in the City of Tualatin Program. This includes, without limitation, claims based upon loss of life, personal injuries, or property damages, sustained by me or caused by me. I agree to assume all risks associated with participation in the program and acknowledge and agree that the City of Tualatin assumes no liability.

Photo/Video Release
I hereby grant to City of Tualatin and its officers, employees, and agents, permission, with no claim of payment, to record my image and comments, regardless of the media used to capture my image and comments, together with the right to use, publish, copyright, and reproduce in whole or in part any such image and/or comment for use by the City for business purposes, including, but not limited to promotional materials, public relations, development, or any other legitimate business purpose of the City. I hereby waive any and all rights that I may have to inspect or approve any such image and/or comments or completed products which incorporate all or part of any such image and/or comments. I hereby release and hold harmless the City from any and all liability arising out of or in any way related to the use of such images and comments, including but not limited to any liability arising by virtue of any blurring, distortion, alteration, illusion, editing, or use in composite form, whether intentional or otherwise, that may occur in the making or processing of the finished product.

Medical Release
Due to the strenuous nature of some activities, the participant, or if the participant is a child, the child's parent or guardian, is encouraged to consult a physican concerning the participant's fitness to participate in the program. In case of an emergency, accident, or illness, I give my permission and consent for the listed participant to be treated by an emergency medical technician and/or medical professional and admitted to a hospital, whether medically necessary or as a precaution. I authorize the City to transport the named participant to the nearest hospital in case of injury or suspected injury while the participant is involved in a city program or activity. I agree to be the party responsible for all medical and hospital expenses accrued on behalf of the listed participant.

Parent Permission
I (we), parent(s) of, or legal guardian(s) for, the listed participant, hereby consent to participation in this City of Tualatin Program. On behalf of the participant listed, I accept the waiver of liability, photo/video release, and medical provisions of this registration form.

By my signature below, I have read the Waiver of Liability, Photo/Video Release, Medical Release, and Parental Permission, understand its terms, including the waiver and release provisions, and voluntarily agree to be bound by the terms therein.

Acknowledgement *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Signature of Parent or Guardian *

Please include first and last name.

YAC Oregon Youth Summit 2/2/24

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