YLSBC- Junior Award Scheme for Schools (JASS) Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

YLSBC is pleased to open the registration to its JASS Program for youth members 6-13 years old. The details of the program can be found at https://www.ylsbc.org/jass. If you have any questions please contact the youth leaders or program directors.

Email *

Parent's email *

Parents' Cellphone Number *

Youth Participant's Name (First, Middle, Last) *

Home # and Street Address *

City and Postal Code *

Youth's Phone number (Area code-###-####) *

Youth's Email Address *

Gender of Youth Participant *

Male

Female

Date of Birth (MM/DD/YYYY) *

YYYY

WAIVER AND AGREEMENT

I will select the activities I will perform to achieve an Award.

I will not attempt to perform any activity until I have made certain that I can perform it safely.

I acknowledge that no one is authorized by the Program to advise as to the safety of any activity or as to whether I am capable of performing it safely, or to supervise or exercise any control or authority over me or any other participant. As a participant, I assume full responsibility for all such matters.

I hereby release and hold harmless each of the individuals and legal entities involved in the Program from any liability of any kind for any injury I might suffer while performing any activity in connection with the Program.

This Agreement shall remain in effect as long as I am participating in the Program.

I agree that my name and other information and/or photographs regarding me and my participation in the Program may be used by the Program in any future publication for the promotion of the Program.

I agree not to reproduce any material in any form; photocopy, scanned copy, etc.

Youth Participant, please add your name in lieu of your signature confirming the above. *

PARENTS/GUARDIAN ACKNOWLEDGEMENT

We are the parent or legal guardian of the Junior Award Scheme for Schools participants listed above. We have read the foregoing Waiver and Agreement, and we agree on behalf of ourselves and the participant to the terms thereof. We will assure ourselves that the participant is aware of and understands the terms thereof.

We will assure ourselves that the participant is aware of the risks involved in each activity and we take full responsibility. We also agree to the fee schedule of $200 for all eight levels of this award. Payment in two batches of $100 each and per the progress of the award. The first batch of $100 is due now on Registration which will cover Four award levels. The payment will be sent on acceptance of your registration.

I also agree to pay any out-of-pocket costs towards park entry fees, museum fees, rentals, and shared food costs incurred during the adventure component.

Parent/Guardian, please add your name in lieu of signatures confirming the above. *

Date of Registration (MM/DD/YYYY) *

YYYY

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms