Register for GUTS! Spring 2023 Middle School Group at Meadowlark
Thank you for your interest in participating in GUTS! this spring! The GUTS! Program is committed to providing positive group and mentoring experiences for our community, especially our girls and gender-diverse youth.  This GUTS! group welcomes 6th-8th grade girls and those who feel they could benefit from participating in a GUTS! group. Both participant and parent/guardian will be asked to e-sign this form so please have both parties present before filling this out.

This session we are offering a new unique way to participate with GUTS!--at Meadowlark, the YWCA building!  To encourage larger groups and create more accessibility to our programming we are now offering a middle school group at YWCA's home-base. 

If you are filling this form out for more than one participant, please fill out two forms for ease of registration processing, thank you!


Spring 2023 session dates: Feb 21st- May 5th
Meeting time: Tuesdays from 4-5:30pm
Meeting location: Meadowlark/ YWCA (1800 S. 3rd St. W.)
Bus stop for Route 9 on Mountain Line right outside of building

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Email *
School year: *
Participant's Name: *
Participating in: *
What school is your student attending for the school year? Write "home school", "MCPS Online Academy", or the name of the school attending in-person. *
Grade: *
Date of Birth *
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DD
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YYYY
Gender: *
Participant's Pronouns:
Address (Street, city, state, zip code): *
Parent/guardian name(s): *
Parent/guardian phone numbers (Home, cell, work):
*
Parent/guardian email address: *
Student email address (but please note that student email addresses created by the school cannot receive emails from outside of that school's district):
Secondary contact Name and Phone Number (if different than Parent/ Gaudian)
Please list any medical/mental condition(s) including allergies that your child has that we should be aware of in working with your child: 
Is your child able to attend the weekly meeting time on Tuesdays from 4-5:30pm at Meadowlark/ YWCA building? 
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If participating in GUTS! after-school, how will your child get home afterwards? 

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Does your child require any accommodations?  If yes, please describe. Or if you would prefer to reach out to our staff to answer this question, please contact Meg Denny, Youth Services Manager at mdenny@ywcaofmissoula.org                                

                    

“YWCA Missoula’s mission is to eliminate racism, empower women and promote peace, justice and dignity for all. We strive for our recruitment to be welcoming to all.” Which of the following best represents your racial or ethnic heritage? Choose all that apply. *
Required
Does your child need any accommodations? If yes, please describe. Or if you would prefer to reach out to our staff to answer this question, please contact Mia McKinney, at mmckinney@ywcaofmissoula.org
How did you hear about GUTS!?

WAIVER & RELEASE AGREEMENT: 

Please read carefully before signing. This is a release of liability and waiver of certain legal rights. In consideration of my being permitted to participate in the activities of Girls Using Their Strengths (GUTS!) and/or the YWCA Missoula, I agree to the following Waiver and Release. 

I understand that I am expected to pick up on time after GUTS! activities.

I confirm that I understand and agree that in the event it becomes necessary for YWCA facilitators in charge to obtain emergency care for my child, neither they nor the YWCA assumes financial liability for medical treatment or expenses incurred because of an accident, injury, illness and/or unforeseen circumstances.

I authorize the YWCA employees and volunteers in charge of the students to obtain all necessary emergency care and authorize any licensed physician and/or medical personnel to render necessary emergency treatment to my child.

COVID-19 Waiver- By registering my child for GUTS! programming, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the program and that such exposure or infection may result in personal injury, illness, permanent disability, and death.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at GUTS!/YWCA or participation in GUTS!/YWCA programming.

I for myself, my heirs, successors, executors and subrogees, hereby KNOWINGLY AND INTENTIONALLY WAIVE AND RELEASE, INDEMNIFY AND HOLD HARMLESS GUTS!/YWCA, their directors, officers, agents, employees, and volunteers from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorneys' fees) which are related to, arise out of, or are in any way connected with my participation in this activity including, but not limited to, NEGLIGENCE, of any kind or nature of GUTS!/ YWCA or from some other cause I, for myself, my heirs, my successors, executors, and subrogees, further agree not to sue GUTS!/YWCA Missoula as a result of any injury, paralysis, or death suffered in connection with my use and participation in the activities of GUTS!/ YWCA.

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MEDIA RELEASE:
(optional) I give permission for my child’s name and/or picture to be used in films, videos, media releases, funder publications, written information or brochures produced to promote the work of the GUTS! and YWCA programming. I agree that GUTS!/YWCA Missoula may photograph and record my likeness and activities. I grant the following rights to GUTS!/YWCA Missoula, their agents and assigns: 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, 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 GUTS!/YWCA Missoula and their agents and assigns from any and all claims arising out of use of the images for the purposes described above, including any claims for libel.
By checking this box, I acknowledge that the electronic signature above constitutes my legal signature. *
Required
If participant is under 18, parent/guardian e-signature (typed name).
By checking this box, I acknowledge that the electronic signature above constitutes my legal signature.
Date E-Signed *
Do you have any questions about the upcoming semester of GUTS! groups? Jess, the GUTS! Program Coordinator, will reach out to you to answer any questions submitted here. Thank you!
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