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GYSD 2023 Registration Form and Waiver

By submitting this form, I agree to the waiver, and I give permission for my child to be a participant in Earth Day/Global Youth Service Day activities with Positive Youth Enrichment, Inc.

Activities will take place outside at Stone Mountain Park. Transportation to and from the drop location, and to neighborhoods for bird feeder distribution will be provided. Participants will be picked up to be transported to the park from A Brighter Day Early Learning Academy, 6267 Memorial Drive, Stone Mountain, GA 30083 at 10AM and returned to A Brighter Day Early Learning Academy, 6267 Memorial Drive, Stone Mountain, GA 30083 at 2PM. Lunch will be provided and I have included any food restrictions below.

During the event, I can be reached at the contact number listed below in the event of an emergency. Should a PYE Representative be unable to reach me, I have listed two additional emergency contacts below.

Contact Information

Parent/Guardian Name

First Name

Last Name

Verify Email

Phone

Child's Name

First Name

Last Name

Age

Food Restrictions

Child's Name

First Name

Last Name

Age

Food Restrictions

Ulternate Emergency Contact #1 Name

First Name

Last Name

Phone

Ulternate Emergency Contact #2 Name

First Name

Last Name

Phone

Waiver

I understand that personal injury may occur and I authorize Positive Youth Enrichment, Inc. staff/volunteers to seek and consent to emergency medical attention for my child as needed; and I further agree to be liable for and to pay all costs incurred in connection with such medical attention.

I release Positive Youth Enrichment, Inc., its employees, agents and volunteers, from any and all liability, claims, or demands related to any loss, damage or injury that may be sustained by my child while participating in or traveling to and from this event.

I give permission for my child to ride in any vehicle designated by Positive Youth Enrichment, Inc. its employees and adult volunteers, while participating in and traveling to and from this event.

I agree to accept full responsibility, financially or otherwise, for any damage my child may do to the property of Positive Youth Enrichment, Inc., properties visited on outing, other’s personal property, or vehicles used for transportation.

Submission of the form signifies that I agree and consent to all of the above stated.