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The New Roosevelt Island Youth Program
REGISTRATION FORM


















I hereby agree to have my child participate, in any programs conducted by the Roosevelt Island Youth Center, Inc. with the exceptions of the restrictions mentioned above. I also allow the Roosevelt Island Youth Program, Inc. to take pictures for the purpose of a program identification card and program enhancement. I understand that the Roosevelt Island Youth Program, Inc., its personnel, and its Board of Directors connect be held liable for any loss of property or injury. I also consent that the participant mentioned above will receive emergency medical care in the event of an emergency with the understanding that the parent, guardian, and/or emergency contact person will be notified as soon as possible.
 

I understand that staff, as well as photographers, newspaper and television reporters, media representatives and public relations personnel may be present during program activities and special events both in-school and away from school. In some cases, they may photograph, interview or otherwise record children who participate in these activities and events. The resulting images, videos, and interviews may be use to promote the programs in printed and electronic media published by out agency, such as brochures, books, print and e-mail news letter, DVDs and videos, websites and blogs. 
 
I give my permission for my child to be photographed, interviewed or otherwise recorded during program activities and special events, whether now or hereafter known or developed.

If you DO NOT wish for your children to participate in interviews or the recording of images as described above, please review this section of the form. ONLY sign in the comments portion below if you do not give permission.


 
I DO NOT give permission for photographs, other recordings or interviews of my child to be used by the program in any publication. As a result, my child may not be able to participate in events and group activities that may be used for publication purposes.