Cincinnati Youth Collaborative

Parent/Guardian Consent Form & Full Release of All Claims


Parent/Guardian Consent Form & Full Release of All Claims 
CYC CONSENT FORM 

Child: .

  1. I give permission for my child named above to participate in Cincinnati Youth Collaborative (“CYC”) program(s). I understand that volunteers in the programs are not school or CYC employees, and that program related activities with my child are intended to help them graduate from high school with the knowledge, skills, attitudes, and behavior necessary to participate fully and responsibly in society. 

  2. I consent for teachers and counselors in Cincinnati Public Schools and other CYC partner schools to share information with the volunteers and CYC coordinator(s) about my child, including electronic and physical scholastic/attendance records, as well as, any health or medical problems my child may have. 

  3. I understand that programs may have activities that take place in and outside of the school, such as visits to a volunteer’s work site, parks, facilities and to other cultural and recreational events. I understand that special permission will be required each time my child participates in a program activity outside the Greater Cincinnati Metropolitan area, an overnight stay, or experiential activities that are different from the normal group activities. If my child is a registered CYC mentee, the CYC mentor is to communicate outside activities with the parent or guardian directly. 

  4. My child has my consent to go to program activities in a private car driven by a volunteer, in a bus, public transportation vehicle, or in a vehicle driven by a school or recreation facility employee.

  5. As a participant in the program, I understand and consent for my child to appear in media/recruitment materials including TV, radio, web, printed materials, newsletters, and social media. If I do not want my child photographed, I will not send him/her to this program or I will send him/her in a face mask and hat or bandana that obscures his/her appearance.  I consent to my child participating in program evaluation surveys and understand I may be required to complete occasional program evaluations. 

  6. I agree to fully release and hold harmless the CYC, its volunteers and mentors, partner schools, facilities, and their agents or employees from any and all claims arising from my child's participation or non-participation in the mentoring program. I understand that the program may include various recreational activities (like basketball, football, soccer, yoga, etc.)  

  7. I also understand that I am responsible for seeing that my child gets to and from the program activities and their locations.   I also understand that the CYC and its mentors, volunteers, workers at program facilities, and CYC staff are not responsible for my child before or after the program ends, and/or if my child chooses to leave a program location early or on their own. CYC programs are not daycare or babysitting. If I have any concerns about my child leaving program facilities or participating in the program, I understand that I am welcome to accompany my child to the program facility and to observe their activities in addition to participating in drop-off and pick-up.  

  8. I support CYC programs and will encourage my child's participation and good behavior. I understand that if my child does not adhere to the guidelines of CYC programs, my child may be removed from CYC programs. 

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Signature Certificate
Document name: Parent/Guardian Consent Form & Full Release of All Claims
lock iconUnique Document ID: c1a5c4958592560c41641ed873331cf1ea4c725a
Timestamp Audit
July 10, 2019 12:42 pm ESTParent/Guardian Consent Form & Full Release of All Claims Uploaded by Chris Lipscombe - clipscom@cycyouth.org IP 72.49.230.250
June 2, 2020 1:32 pm ESTCheri Jordan - cjordan@cycyouth.org added by Chris Lipscombe - clipscom@cycyouth.org as a CC'd Recipient Ip: 74.141.194.91
July 17, 2020 1:03 pm ESTCheri Jordan - cjordan@cycyouth.org added by Chris Lipscombe - clipscom@cycyouth.org as a CC'd Recipient Ip: 74.141.194.91
September 21, 2020 3:21 pm ESTCheri Jordan - cjordan@cycyouth.org added by Chris Lipscombe - clipscom@cycyouth.org as a CC'd Recipient Ip: 74.141.194.91
January 18, 2022 1:44 pm ESTCrystal Smith - csmith@cycyouth.org added by Chris Lipscombe - clipscom@cycyouth.org as a CC'd Recipient Ip: 65.186.81.2
October 25, 2023 3:46 pm ESTCrystal Smith - csmith@cycyouth.org added by Chris Lipscombe - clipscom@cycyouth.org as a CC'd Recipient Ip: 72.49.230.250