Service Learning in Public Policy Registration

Founding Forward does not carry medical insurance to cover participants. All participating students should be covered by personal or family insurance.

We (I) hereby certify, under penalty of perjury, that the above named student is covered by medical insurance.

We (I) hereby give permission for the above named student to attend Service Learning in Public Policy on the dates listed above to be conducted at the Valley Forge Campus of Founding Forward.

We (I) hereby release and discharge Founding Forward, its officers, agents, instructors and employees, from any and all claims, demands, suits, actions or causes of action which we (I) may or shall have reason of any illness, injury or accident incurred or suffered by the above named participant at this conference and in the course of travel by any means to and from and while on the premises of the Valley Forge Campus of Founding Forward, no matter how caused or occasioned

I, the undersigned, on behalf of my child listed above hereby grant absolute right and permission to Founding Forward to take photographs, video, verbal or written testimonials and/or audio reproductions of the person(s) named above and to copyright, use, publish, and distribute same.

In granting such permission, I hereby relinquish any right, title or interest in such photographs, video, verbal or written testimonials, CD ROMs, DVDs, and/or audio reproductions and grant Founding Forward permission to publish, exhibit or use such audio/visuals for any and all promotional purposes stated, including but not limited to broadcast, website, social media, promotional videos, press releases, e-newsletters, and other print and/or electronic uses.

I, the undersigned, certify that I am 18 years or older and have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

As a participant in the Service Learning and Public Policy program, I agree to:

· Participate in all activities to the fullest extent possible.

· Be on time to all scheduled events.

· Show respect to my fellow participants, adults leaders, and myself.

· Leave the campus — classrooms, dormitories, dining hall, etc — in the same condition I found them.

· Follow all rules and instructions as communicated by the program director and staff.

· Honor wake up time and lights out times.

· Behave in a way that is always safe for me and others.

· Make this weekend alcohol, tobacco, and drug free.