Women’s March Youth Empower 2020 Youth Rising Permission Form
This form must be completed by the Parent/Guardian of any individual under the age of 18 years old who is attending the 2020 Youth Rising Event on January 17, 2020.

PARENTAL/GUARDIAN CONSENT
The undersigned does hereby give permission for my child/dependent to attend and participate in its entirety Women’s March Youth Empower’s Youth Rising Event on January 17, 2020.

LIABILITY RELEASE: In consideration of Women’s March, Inc. allowing the Participant to participate in 2020
Youth Rising event, I, the undersigned, do hereby release, forever discharge and agree to hold harmless
Women’s March, Inc., its staff, volunteers, contractors, and partners (collectively herein the “Women’s March
Network”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as
property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the
Participant while involved in the event on January 17, 2020.

I, the parent or legal guardian of this Participant, hereby grant my permission for the Participant to participate fully in the activities of this event. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify said Women’s March Network for any liability
sustained by said Women’s March Network. as the result of the negligent, willful or intentional acts of said
Participant, including expenses incurred attendant thereto.

EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation coordination, costs and responsibility.

Parent/Guardian must entrust to their own chaperone responsibility for any healthcare-related emergencies while
the child is at the event.

Photo Release Form for Children and Youth

I agree that Women’s March Network. may photograph and record my child/dependent’s likeness and activities
(Images) during the event on Friday, January 17. I grant the following rights to Women’s March Network: 1
permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use
of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now
existing or subsequently developed, on the Women’s March Network and Youth Empower website and on the
Internet, and worldwide in perpetuity for the purposes stated above. I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge Women’s March Network. from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act. I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 18 and have legal capacity to sign the release or I have permission from my parent/guardian for this photo release form.

**Image means all photographs, film, or other recordings taken of you as part of the event.
Email address *
Youth's Name *
Your answer
Youth Age *
Your answer
Youth's Pronouns *
Your answer
Youth's Date of Birth *
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YYYY
Youth Phone Number *
Your answer
Youth Email Address *
Your answer
Primary Address *
Your answer
Parent/Guardian's Name *
Your answer
Parent/Guardian's Phone Number(s) *
Your answer
Parent/Guardian's Email(s) *
Your answer
Emergency Contact #1 Name, Phone Number, Relationship *
Your answer
Emergency Contact #2 Name, Phone Number, Relationship *
Your answer
Date *
Your answer
Parent/Guardian Signature: I understand by inputting my name below, I am providing a signature in effect and giving permission for the above. *
Your answer
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