YMCA OF METROPOLITAN WASHINGTON EMPLOYMENT AND VOLUNTEER CONSENT FORM In connection with my application for employment and/or continued employment, I understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me, including my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, sex offender registry, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics or mode of living, and trustworthiness. These reports may include employment and credit experience along with reasons for termination of past employment. I hereby authorize and consent to the Young Men’s Christian Association of Metropolitan Washington’s (the YMCA”) procurement of consumer and/or investigative consumer reports. I further authorize ongoing procurement of the above- mentioned reports at any time during my employment. I understand that, pursuant to the federal Fair Credit Reporting Act, the YMCA will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with the YMCA. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. I have the right to make a request of Employment Screening Alliance, Inc. (or such other credit reporting agency that produced the report), upon proper identification and the payment of any authorized fees, for the information in its files on me at the time of my request. I hereby release Employment Screening Alliance, Inc. (or such other credit reporting agency that produced the report), the YMCA, and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, of whatever kind, to me, my heirs, or others making such claim or demand on my behalf, for procuring, selling, providing, brokering, and/or assisting with the compilation or preparation of the consumer report and/or investigative consumer report hereby authorized.
October 15, 2024YMCA Media Waiver and Code of Conduct ACKNOWLEDGEMENT
I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the YMCA’s programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, athletic activities, sports programs/classes, the use of any equipment, exercise, or other activities or from my or my minor child(ren)’s or ward(s)’ physical condition. I understand that the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns assume no responsibility for loss, damage, illness or injury to person or property that I or my minor child(ren) or ward(s), if applicable, may sustain as a result of my or their physical condition or resulting from my or their participation in any activities, programs, events, classes, the use or non-use of any equipment, exercise, horseback riding, archery, field trips, waterfront and pool activities, canoeing/boating, campfires, hiking, high ropes and other challenge courses, or any other activities, classes, events, or programs at and/or sponsored by the YMCA. I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my or my minor child(ren)’s or ward(s)’ participation in any events/activities/programs/classes while at the YMCA and/or sponsored by the YMCA. I also acknowledge that the YMCA often uses photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) are an integral part of such photograph, videotape, television program, motion picture, tape recording, or other similar media.
RELEASE
In consideration of the YMCA allowing me and/or my minor child(ren) or ward(s) to attend and/or participate in any programs, events, classes, or other activities at the YMCA and/or sponsored by the YMCA, I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my attendance and/or participation in any such programs, events, classes, and other activities, whether or not such loss, damage or injury results from the negligence of the YMCA and its employees, agents, or representatives or from some other cause. My agreement to release the YMCA does not include any loss, damage or injury that results from the YMCA's gross negligence or willful, wanton, or reckless misconduct. I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es). I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the YMCA and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) in any such materials. INDEMNIFICATION I hereby represent and warrant to the YMCA that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s), or any other person nevertheless asserts any claim against the YMCA arising out of my or my minor child(ren)’s or ward(s)’ participation in any program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend the YMCA from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the YMCA or from some other cause. ACCEPTANCE I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form. October 15, 2024
YMCA DC YOUTH & GOVERNMENT PROGRAM EXPECTATIONS FOR ADULT PARTICIPANTS
1. Adult program participants are expected to abide by the Code of Conduct for Students and be willing to enforce it at all times when attending a Youth & Government activity. 2. Adult program participants are expected to report all violations of the Code of Conduct to the Program Director immediately. In the event that the violation is minor in nature and if it is after 1:00 AM, they may report it to the Program Director the next morning. 3. Adult program participants are expected to be present in the program area assigned to them at all designated times. 4. Adult program participants are expected to have another adult present whenever they:
a. patrol the hallways before and after curfew; b. need to talk with a student in a private setting; or c. transport a single student to a Youth & Government program activity, to a doctor, or to a hospital.
5. Adult program participants are expected to have at least two students present if I am transporting students to a Youth & Government program activity and there is no other adult traveling with them. 6. Adult program participants are expected to read all notes that have been given to them prior to permitting them to be passed on to others. 7. Adult program participants are expected not to share hotel accommodations with students during a Youth & Government program activity. 8. Adult program participants are expected to have all of their students sign code of conducts and participant waivers before they permit any student to travel to any Youth & Government activity. 9. Adult program participants are expected to conform to the core values of the YMCA and this program. 10. Adult program participants are expected to have completed a thorough background check. In any case, agree that they have never committed a crime involving a minor or sexual offense. 11. Members’ health and safety are very important to the YMCA and therefore we ask you respectfully refrain from the use of incense, tobacco products and the use of or possession of alcoholic beverages or non-prescription drugs. Possession or use of a firearm or other instrument that could be used as a weapon is forbidden at any Y&G function. I have reviewed these expectations. I understand that the Program Director may terminate my affiliation with the program if I am found to be in violation of any of these expectations.
October 15, 2024
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