HSCL Youth and Family Village Registration Form

Thank you for joining our Youth and Family Village
Caregiver Information

 
 
 
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Youth Information

 
 
 
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Additional Information

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HSCL YFV Waivers

Liability Agreement Waiver and Release Parent Consent:  I hereby consent that my child may participate in the Heart and Soul Center of Light Youth and Family Village program.  I state that said minor is physically able to participate in said activities.  I understand that hold Heart and Soul Center of Light, its agents and its employees harmless from any and all liability claims including but not limited to, claims of injury, illness, accident, or death that occur during or by reason of participating in Heart and Soul Center of Light Youth and Family Village.
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MEDIA WAIVER: I consent to Heart and Soul Center of Light making use of photographs and recordings made by Heart and Soul and/or its licensees for any purpose.  Such uses include without limitation the transcription, modification, reproduction, public display, distribution, broadcast, and transmission in any form. I release Heart and Soul, and its licensees, from and waive any claims related to or arising by reason of the making and/or use of any such recordings and acknowledge that there will be no payments for release or of any royalties. I grant Heart and Soul, and its licensees, the right to use, in connection with the promotion and outreach of Heart and Soul, my name, likeness, and any trade name and/or logo. The provisions of this paragraph will survive termination of any additional agreements.

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Description

Thank you for joining our Youth and Family Village