YOUTH MEMBERSHIP FORM

By signing below, I hereby give permission for my child/dependent to become a member of Aspen Youth Center (AYC). I understand that my child/dependent may enter and leave AYC at will. AYC is not responsible for personal injury or loss of personal property. I give permission for my child to participate in any activities offered at AYC and understand the nature and potential risks of such activities including injury and/or bodily harm.

I understand that in the case of an emergency involving my child/dependent, every effort will be made to contact me and/or the individual designated on this form as “Emergency Contact”. In the event that neither I, nor the designated “Emergency Contact” can be reached, I hereby give the AYC Staff my permission to contact emergency medical services and enlist available medical professionals in the evaluation and treatment (including surgery) of my child/dependent.

In addition, I authorize AYC to use and reproduce any and all photographs and/or video footage of my child/dependent which may be taken in connection with AYC activities for any purpose without compensation. I understand that all such photographs and/or video footage of my child/dependent is the sole property of AYC.

I understand that my child/dependent may be asked to participate in evaluations and/or surveys and that any information my child/dependent provides will only be used internally by AYC.

I understand that, as a member of AYC, my child/dependent will have access to the internet and while precautions are in place, it is possible that my child/dependent may access inappropriate web sites. AYC does have rules regarding such behavior but I understand that AYC cannot be responsible for any consequence of such access.