YWCA Olympia partners with Thurston County Public Health and Social Services, Synthesis Services LLC, and your child’s school. This partnership works together to understand, assess, and meet the needs of adolescent girls in our communities by way of a program evaluation. This program evaluation is a stipulation of our YWCA of Olympia funders, and will provide us with invaluable information and feedback on how Girls Without Limits! is impacting our program participants. All participants will be asked to complete a pre and post-program survey. All surveys are anonymous and are processed in a confidential manner. While participation in the survey is required, all survey questions are optional. In order to provide your child and family with the best services and support possible, we need your permission to share anonymous survey information with the evaluation team: By enrolling the child listed above in Girls Without Limits!, I understand that I am authorizing the release and exchange of student records between The YWCA of Olympia employees, Thurston County Department of Public Health and Social Services, Synthesis Services LLC, Office on Women’s Health, and my child’s school. This includes information contained on this registration form, as well as program evaluation data. I understand that for the purposes of coordinating support for my child, that YWCA of Olympia employees may also verbally share information regarding my child’s education and development. Those receiving information under this release understand that this information is protected under state and federal law. They are not authorized to release it to any agency or person not listed in this release without specific written consent of the parent/legal guardian. This permission is effective from 09/01/2018 until 10/31/2019 unless cancelled in writing.
The health, safety and well-being of community members participating in YWCA Olympia programs is of the utmost importance.
On behalf of my minor child (youth named on this registration), I hereby give permission for my child to participate in YWCA Youth Programming.
I do hereby agree and consent to my youth’s participation in YWCA Olympia Youth Programs and do assume all risks and hazards which are part of the conduct of the associated activities. I hereby release, absolve, indemnify, and hold harmless YWCA Olympia, their officers, directors, employees, contracted employees, independent contractors, instructors, agents, organizers, and volunteers of any and all liability for damage, injury, or expense of any kind arising out of or connected with my youth’s participation in YWCA Programs.
I understand that in case of a medical emergency, my own personal medical plan will be used. As a condition of my youth’s participation in YWCA Programming, I acknowledge that I have read this consent form, and knowingly, assume all of the risks associated with participating in any way in YWCA Programming.
I hereby release, to the fullest extent permitted by law, the YWCA Olympia and their affiliates, from any and all actions, claims, demands, or liabilities that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my child’s participation in these activities irrespective of whether the same is based on breach of warranty, negligence, strict liability or any other theory or
recovery.
