Facebook
Twitter
Linkedin
Youtube
Register
Login
About Us
Vision & Mission
What We Do
The Challenge & Our Solution
Our Program
Kitchens
Impact & Reach
COVID-19 Relief
Who We Are
Board of Trustees
Board of Advisors
Management Team
Financials
Get Involved
Create a Campaign
Find a Campaign
Join or Start a Chapter
Become a Volunteer
Youth Ambassadors
Corporate Partnerships
Large Gifts
TAPForums
Events
Events Calendar
Past Speakers
News
Blog
Gallery & Media
Contact
Donate
Login
Register
Search
Menu
Youth Ambassadors Parent Consent
Youth Ambassadors Program participant
Name
Last Name
Birth Date
Date Format: MM slash DD slash YYYY
To parents/guardians of Minor:
Thanks you for completing this form. The Completed form is a mandatory for your student’s particiaption in the Aksaya patra Youth Ambassadors Program. The CONSENT and RELEASE shall be effective as of the dates noted in the each section below and shall remain valid for the duration of the participants involvent in the Youth Ambassadors Program, or such earlier time as this consent and release is rescnded in writing by the undersigned parent(s) or guardian(s). Parent please upload this Signed form a a PDF signed form as a PDF to section One of the Youth ambassadors Aplication before submission of application. Part One: Program Consent and Authorization i/we undesrtand that the Youth Ambassadors Program is a facilitate youth program of the Akshaya Patra Foundation Usa. The Program well be conduced in online and in-person formats. Further, my Participant will lead and conduct donor recruiment through face-to-face and house meetings, community events, and other arrangements of their choosing. I / We as undersigned parent(s)/ guardian(s) of
Minor name
, a minor, do heardy give consent to her/his participarion in the Youth Ambassador Program run by Akshaya Patra Foundation USA. i/we RELEASE and discharge the Akshaya Patra Foundation USA from any and all claims, damages, losses or exprenses of whatever kind or nature which said minor may have or acquire arising out of or resulting from directly or indireclty, his/ger participation in the Youth Ambassadors Program. i/we RELEASE Akshaya Patra Foundation USA from all liability not directly related to the action of Akshaya Patra Foundation USA staff members. i/we furthermore agree to defend and INDEMNIFY Akshaya Patra Foundation USA against all claims, damages, losses or expenses of whatever kind or nature which said minor may have or acquire arising out of or resulting from, directly or indirectly his/her participation in the Youth Ambassador Program. This Autorization and Consent may be presented to the appropriate emergency medical staff at such time as emergency medical care required. I heareby RELEASE and discharge Akshaya Patra Foundation USA from any and all claims of any nature whatsoever, wtch may arise out of the decisión to provide emergency medical care. I Affirm that the information provided is accurate and complete and I agree to hold Akshaya Patra Foundation USA harmless if full disclosure of a pre existing medical condition has no been provided.
Relationships to participant
Date
Date Format: MM slash DD slash YYYY
Signature
Survey /program Evaluations
i/we grant Akshaya Patra Foundation USA permission to requesst program feedback in the form of surveys amd program evaluation form the participant liste don the page one. I / We understand that the responses may be utilized in the testimonials about the Youth ambassadors Program. In addition, survey responses may be included in long term program evaluation studies. Identities of individuals in the long term studies are kept confidentials.
Relationships to participant
Date
Date Format: MM slash DD slash YYYY
Signature
Image /sound / Media
I/ we the undersigned parent(s) or guardian(s) of participant liste on page one, do hereby grant to Akshaya Patra Foundation USA’s Youth Ambassadors Program consent to créate, use, reproduce, assign and/or distribute photographs, fils, video, digital images and sound recordings of this participant for use in materials they créate at any time without prior notification for publicity and/or for documenting Youth Ambassadors Program participation in an organized fundraising, evento r activity at any time and without prior notification.
Relationships to participant
Date
Date Format: MM slash DD slash YYYY
Signature
CAPTCHA
Scroll to top
?>
