Registration Form for Returning Students

The undersigned parent/guardian certifies that the health information provided for my child is accurate and complete to the best of my knowledge. In the event that my child becomes ill or injured while participating in UpBeat NYC program activities, I authorize UpBeat NYC staff to provide basic first aid and to seek appropriate medical care, including emergency treatment, when necessary. I understand that every reasonable effort will be made to contact me and/or my designated emergency contacts prior to obtaining such treatment. However, if I cannot be reached, I authorize UpBeat NYC staff to consent to medical care on my behalf, including but not limited to diagnostic tests, x-rays, and hospitalization, as deemed necessary by licensed medical professionals. I authorize the release of relevant medical information as necessary for treatment, referral, billing, or insurance purposes. I understand that I am responsible for any medical expenses incurred and agree to assume full financial responsibility for such care.

UpBeat NYC documents its programs through photography, video, and audio recordings. By signing below, I grant permission for UpBeat NYC to photograph, film, and/or record me and/or my child during program activities. I authorize UpBeat NYC to use these images, recordings, and/or my/my child’s likeness and voice in publications, promotional materials, and other media, in any format now known or later developed, without compensation or further approval. I understand that these materials may be used for educational, marketing, and promotional purposes. I waive any right to inspect or approve the finished product and release UpBeat NYC from any claims arising from such use. This permission is granted by me as the parent/guardian of the child named below and remains in effect unless I provide written notice to UpBeat NYC revoking consent.

I give permission for my child to be transported to and from UpBeat NYC program activities and events, including transportation in vehicles driven by authorized UpBeat NYC staff or approved volunteer drivers. Caregivers will be advised before activities/events that require transportation and can always opt to not give permission for specific events. I understand that such transportation may include the use of personally-owned vehicles. I acknowledge that drivers of personally-owned vehicles are responsible for maintaining their own automobile insurance and that UpBeat NYC does not provide insurance coverage for property damage, personal injury, or liability arising from the use of such vehicles. I understand that reasonable efforts will be made to ensure safe transportation, including the use of properly licensed drivers and appropriate safety measures. In the event of an emergency, I authorize UpBeat NYC staff to arrange transportation for my child as necessary, including transport to a medical facility.

I give permission for my child, (enter child’s name below) to participate in the UpBeat NYC program and its activities. I understand that participation in program activities may involve inherent risks, including but not limited to physical activity, travel, and the use of equipment, which may result in injury. I acknowledge that, while UpBeat NYC will take reasonable precautions to ensure participant safety, it cannot guarantee that my child will be free from injury. I voluntarily assume all risks associated with my child’s participation in the program. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless UpBeat NYC and its officers, employees, and agents (the “Releasees”) from and against any and all claims, liabilities, damages, or expenses arising out of or related to my child’s participation in the program. This agreement is not intended to, and does not, release the Releasees from liability arising from their own negligence to the extent such liability cannot be waived under applicable law. I understand that such transportation may include the use of personally-owned vehicles. I acknowledge that drivers of personally-owned vehicles are responsible for maintaining their own automobile insurance and that UpBeat NYC does not provide insurance coverage for property damage, personal injury, or liability arising from the use of such vehicles. I understand that reasonable efforts will be made to ensure safe transportation, including the use of properly licensed drivers and appropriate safety measures. In the event of an emergency, I authorize UpBeat NYC staff to arrange transportation for my child as necessary, including transport to a medical facility.