Waiver and Release Agreement
This form grants permission for students to participate in A Step Ahead Foundation programming and to use a student's photo, name, and testimonial for promotional purposes.

If you would like a copy of the following information, please email Amy Mulroy at amy@astepaheadfoundation.org.                                  
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Email *
Child's First and Last Name *
I hereby give permission for my child to participate in A Step Ahead Foundation’s presentations designed to lower teen pregnancy and increase high school and college graduation rates in Memphis. *
Required
I understand that the program will discuss pregnancy prevention options with the teens and adults at the presentations.
I hereby waive, release, discharge, and agree to hold harmless A Step Ahead Foundation (hereafter “ASAF”) their officers, agents and employees from any and all claims, demands, rights, causes of action or other liabilities of any kind or character, present or future, whether known or unknown, anticipated or not anticipated, which may occur as a result of my minor child’s participation. I also agree to allow evaluation tracking and research for statistical purposes only.
I ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND THAT AS PART OF THE PROGRAM THERE WILL BE DISCUSSIONS OF SEXUAL HEALTH AND FAMILY PLANNING. I AM FULLY AWARE THAT THIS AGREEMENT WILL HAVE THE EFFECT OF RELEASING AND HOLDING HARMLESS ASAF, ITS OFFICERS, AGENTS, AND EMPLOYEES FROM ANY AND ALL LIABILITY OR CLAIMS OF ANY KIND WHICH MAY OCCUR AS A RESULT OF MY MINOR CHILD’S PARTICIPATION IN THE PROGRAM AND RELATED ACTIVITIES AT ANY FACILITY AND ONLINE PLATFORM.
Name of Parent or Guardian *
Name of Youth Participant (under age of 18) *
Age of Youth Participant *
Sex of Youth Participant *
Date of Birth of Youth Participant *
Zip Code *
Email address *
School *
Today's Date *
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I understand that my child may be photographed/videotaped while participating in the Girl Talk program. A recognizable image of my child (NAME ABOVE) may be taken by an official photographer or videographer of A Step Ahead Foundation, to be used as a still photograph, slide, or videotape for use in the news media, or for the purpose of promoting A Step Ahead Foundation and its programs to potential members, supporters and benefactors. *
Required
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