UYC STUDENT & LEGAL GUARDIAN AGREEMENT

The Urbana Youth Center (“UYC”) is a facility located at 160 West Market Street, Urbana, Ohio, 43078 maintained by the Urbana Youth Center LLC, a wholly-owned subsidiary of the GrandWorks Foundation, for multiple purposes including homework and study assistance, hangout spaces, providing food, basic life skills, and other programming and services. I/we, the undersigned, hereby provide consent and permission for my minor child (“Student”), for whom I am the legal guardian, to attend and utilize all services and programs of the UYC.

General Permission

I/we (“I”) agree to allow my Student to attend the UYC on any day and at any time the UYC is open. I understand the UYC may update its hours of operation and agree to all future revisions thereof. The UYC operates various programs at various locations and I provide permission for my Student to make use of any and all current and future programs of the UYC regardless of location. I understand that my student’s presence at the UYC is a privilege and is solely at the discretion of the UYC staff. I accept that my Student’s access to UYC may be revoked at any time with or without cause. I/we on behalf of myself/ourselves and the Student hereby expressly agree to the policies, terms and conditions set forth by the UYC and found on this page and at https://UrbanaYouth.Center/policy

I agree to allow UYC to use my or my child’s photograph for all legal purposes, including, but not limited to, publicly to promote UYC. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

Transportation

The UYC provides transportation to its facility from various locations in the community, including but not limited to Urbana Junior High School, Urbana High School, and Urbana Youth Center. I understand transportation may be provided in multiple forms including but not limited to school bus, transit bus, and personal vehicles. I provide permission for my student to use any form of UYC transportation on any day and at any time it is so offered. I further understand this means my student may use this transportation instead of transportation arranged by Urbana City Schools or any other properly authorized entity. From time to time, the UYC provides programming and field trip opportunities away from its primary location. I provide permission for my student to attend such programming and field trip opportunities and utilize UYC transportation. In the event of a medical emergency, UYC may transport or authorize transport to a medical facility and may consent to treatment for my student on my behalf. I understand that a failure to provide my/our express written consent to the UYC will result in the UYC’s refusal to allow Student to utilize the aforementioned transportation.

General Assumption of Risk & Liability

Knowing the risks present at the UYC and in consideration of being permitted to participate in and/or observe the activities conducted at the UYC, on behalf of myself and my student, I hereby freely and voluntarily assume any and all risks whether known or unknown arising from or in any way connected the UYC or any use of the UYC facilities, technology, tools, services, or equipment. To the maximum extent permitted by law, for myself, my heirs, personal representatives and assigns, I hereby waive, release discharge and hold harmless from and indemnify the UYC and its Board members and the governing boards of all UYC and GrandWorks Foundation members, their respective members, officers, employees, agents, attorneys, representatives, volunteers, and assigns (“Releases”), against any and all claims, present and future, damages, demands, liability, rights of action, and causes of action arising out of or in any way connected with my or my minor child’s presence at the UYC or our use of the facilities, technology, tools, services, or equipment, including without limitation, liability for any loss of property, death, or injury suffered by me and/or my minor child, or for which either of us may be liable to any other person resulting from any cause including, but not limited to, the negligent act or omission of Releases. The foregoing shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, those of my minor child, and for all members of my family. Because of the inherent dangers of participating in these activities, I recognize the importance of me/my student following instructors and/or mentors’ instructions regarding training, safety precautions, policies, and other rules, etc., and agree that my student and I will obey such instructions without exception.

General Child Care Authorization

I, the undersigned parent or guardian, hereby grant the Urbana Youth Center and any of its properly authorized representatives (hereinafter “Caretaker”), the authority to take temporary care of my Student(s) to be invoked only at the discretion of UYC. This grant of temporary authority shall begin on the date first signed and shall remain effective until terminated by me, the parent/guardian.

The above named Caretaker shall have the power to: seek appropriate medical treatment or attention on behalf of my Student(s) as may be required by the circumstances and at Caretaker’s discretion authorize medical treatment or medical procedures in an emergency situation; make appropriate decisions regarding clothing, bodily nourishment, transportation, and shelter; provide permission for my Student(s) to be absent from school and/or explain absences from school; pick Student(s) up from school; sign release forms, waivers, or other legal documents on my behalf that might be required for my Student(s) to participate in activities provided by UYC or in connection with UYC services or partners; access and review Student’s grades and school files, including Student’s attendance and discipline record, with the Student directly, individually, or through a school employee.

Agreement

By signing this agreement electronically, by text message using the response “YES” or “I agree” or via email or via physical signature or other permissible means, I, the undersigned, hereby agree to all the terms and statements set forth in this agreement. I warrant that I am the legal guardian of the student on-file with UYC and provide consent from the date of signing forward for my student to access and utilize all services of the UYC including transportation. I understand that this consent and agreement remains in effect in perpetuity. I may provide written notice to UYC at its address listed above to revoke my Student’s privileges to attend, but no such action will void any part of this agreement.