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First JYF Con of the School Year Form

Complete the fields on this form and submit by clicking the send button

This form includes the following:

  • Medical History and Information
  • Emergency Contact Information
  • Release and Agreement for JYF Cons
  • Use of Likeness Release
  • Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

Medical History and Information

First Name *
Last Name *
Month
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Day
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Year
Doctor's Phone (Required)
ext Extension
Please upload a photo of the front of your JYFs insurance card.
No file selected
Please upload a photo of the back of your JYFs insurance card.
No file selected

Emergency Contact Information

First Name *
Last Name *
First Name
Last Name
First Name
Last Name

Release and Agreement for Junior Young Friends Conferences

In consideration of being allowed to participate in the youth programs of Baltimore Yearly Meeting, its related events and activities, I the undersigned, acknowledge, appreciate, and agree that:

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or other, and assume full responsibility for my participation; and,
I willingly agree to comply with the Gathering Expectations. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring the issue to the attention of the FAPs or Youth Programs Manager immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the Baltimore Yearly Meeting of the Religious Society of Friends, Inc. (BYM), its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity, with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence or participation, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law; and,
I understand transportation to and from conferences is my responsibility and release BYM, staff, and volunteers from responsibility unless transportation is provided by the program.
I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
Month
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Day
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Year

For Guardians/Parents of Junior Young Friends of Minority Age

I, as parent/guardian with legal responsibility for this participant, do consent and agree to my child's release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even if arising from the negligence of the releasees, to the fullest extent permitted by law.
Month
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Day
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Year

Use of Likeness Release

I understand and agree that photographs of myself/my child may be printed in promotional materials. I further understand and agree that my/my child's likeness, in photographs or videos, may appear on a webpage or webpages produced by Baltimore Yearly Meeting and that such webpage(s) will be accessible via the Internet. I agree that any materials produced pursuant to this release may be used, in whole or in part, without inspection or further consent or approval by me, of the finished product or any use of said materials or product by BYM Youth Programs. I have read this agreement, and I make it willingly on my behalf or that of my child.
Month
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Day
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Year

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

In consideration of being allowed access to Baltimore Yearly Meeting’s (BYM) Youth Programs In-Person programming, the undersigned acknowledges, appreciates, and agrees that: The coronavirus (COVID-19) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and can spread from person-to-person and from contact with infected surfaces. Any interaction with others includes possible exposure to and illness from communicable diseases including, but not limited to, influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of contagion, serious illness, injury, disability, and death does exist in any interaction with others. I acknowledge and understand this risk, and I participate in BYM’s programming voluntarily, assuming full responsibility for engaging in the activities that have brought me to BYM’s programming. BYM has implemented the health and safety precautions recommended by the Centers for Disease Control (CDC) and the Occupational Health and Safety Administration (OSHA), including requiring visitors, vendors and employees to use face coverings in public areas. I willingly agree to comply with these health and safety requirements, and to take all reasonable and necessary additional precautions to protect against communicable diseases while participating in BYM’s events, not only for my benefit but for the benefit of others with whom I come in contact. If I observe any objects, practices or procedures I believe to be hazardous while I am at a BYM event related to COVID-19 infection or exposure, I will remove myself from the location of such hazard, and will bring it to the attention of BYM immediately. On behalf of myself and my heirs, assigns, personal representatives and next of kin, to the fullest extent permitted by law, I hereby fully and forever release and hold harmless BYM, its owners, officers, directors, representatives, officials, agents, employees, successors, assigns from and against any and all claims, demands, rights of action, suits, judgments, losses or expenses of any nature (including without limitation attorney’s fees, costs and disbursements), arising out of, or relating directly or indirectly to, exposure to contagious illnesses (including influenza and COVID19) at BYM’s events. This includes claims that arise from my own and others’ actions and omission, excepting only those which arise from the gross negligence, recklessness or intentional torts of the BYM Releasees. I will defend and indemnify BYM Releasees with respect to any released claim. By signing this waiver and release, I acknowledge and agree that I understand the contagious nature of COVID19, and I voluntarily assume the risk that I, my children, or anyone for whose health I may be responsible may become infected, exposed, or otherwise contract COVID19 while at BYM events. I acknowledge that I have joined BYM events for my personal benefit and satisfaction.
First Name *
Last Name *
Month
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Day
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Year

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