I understand that my child’s full name, address, and biographical information will not be made public. I further grant First Generation Leaders of America the right to use, and to allow others to use, my child’s image and/or voice on the internet, in brochures, and any other medium, and hereby consent to such use. I hereby release FGLA, usage of any of my child’s image and/or voice, artwork, and/or written work under this media release form any claims, damages, liabilities, costs, and expenses which I or my child now have or may hereafter have because of any use thereof.

I give my permission for First Generation Leaders of America to collect information via online or written surveys, questionnaires, interviews, and focus groups from the minor child listed on this application. Any and all information received will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and exclude all references to individual responses. The aggregated results of these analyses may be shared with program staff, First Generation Leaders of America, funders, and other community stakeholders to evidence program effectiveness and/or program impact on our members. This release may be revoked at any time by contacting First Generation Leaders of America in writing.

As a participant in the programs of First Generation Leaders of America, our child may have access to the internet. While First Generation Leaders of America has rules prohibiting such conduct and precautions are taken to prevent such access, it is possible your child may access inappropriate sites. First Generation Leaders of America will not be responsible for such unauthorized access.

I give my permission for my child’s picture, video image, or any other graphic depiction or likeness, to be used by First Generation Leaders of America, its affiliates, partners, or donors, and acknowledge neither my child nor I will receive payment for same.

I understand that First Generation Leaders of America is not responsible for lost or stolen items. Each program has the right to make participation decisions based on the resources and capacity of their facility and staff. First Generation Leaders of America reserves the right to decline the application, rescind the enrollment of, or suspend any youth that cannot successfully associate with other participants.

Parents and program participants may be responsible for their own transportation to and from program sites, unless otherwise specified. I understand that written permission is required for First Generation Leaders of America to transport my child.

I give my permission to First Generation Leaders of America to share information about the minor child listed on this application for research purposes and/or to evaluate the program’s effectiveness. Information that may be disclosed may include the information provided on this application form, information provided by the minor child’s school or school district, and other information collected by First Generation Leaders of America, including data collected via surveys or questionnaires. All information provided will be kept confidential. This release may be revoked at any time by contacting First Generation Leaders of America in writing.

I, and all named individuals above, agree to abide by the rules and regulations set by First Generation Leaders of America I understand that violations of the rules and regulations, or misrepresentation of information on this form, may result in restriction, revocation, reduction or loss of program privileges without refund. Waiver and Release: I hereby waive and release First Generation Leaders of America , its officers, agents and employees, from and against any claims, suits, losses, or related causes of action for damages, including attorney’s fees and court costs, that may result from injury or death, accidental or otherwise, during, or arising from my child’s participation in a recreation program, including transportation to and from activities associated with the program, and any resulting illness and/or injury, and I agree to indemnify and hold harmless the First Generation Leaders of America from and against any and all such claims. I recognize that the recreational events or activities being entered into by my child can be dangerous to my child and I accept those dangers. I understand that if my child is injured, this waiver will be used against me and anyone else claiming damage in any legal action because of my child’s injury. I hereby acknowledge that I understand and am familiar with the nature of the activities in which my child will participate at this facility, and affirm that my child is in good health and that my child does not have a physical or emotional condition, past or present, of which I am aware, which would in any way affect my child’s ability to participate in recreation programs. I also understand that I should have health and accident insurance to cover injuries arising from participation in recreation programs. I also understand that I am responsible for immediate pick-up of my child upon completion of the program the child was registered in.