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Peace in Schools

PARTICIPATION AGREEMENT

Peace in Schools is a non-profit organization whose mission is to offer mindfulness-based social-emotional education for youth, helping young people to develop compassion, calm, emotional resilience, and self-awareness. Mindfulness is not religious; it can be practiced by anyone of any religion or no religion. We welcome all teens!

 

Participant Information
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First Name
Last Name
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(mm/dd/yyyy)
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Emergency Contact Information
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(Emergency Contact must be at least 18 years of age)
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(Mother, Grandmother, etc.)
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Publicity Release Agreement

I give Peace in Schools permission to include the participant and their artwork (visual and written) for unlimited promotional and advertising purposes in perpetuity (i.e., brochures, newsletter, consumer print, broadcast, books, internet, retail, events etc.). Peace in Schools is a nonprofit organization. Peace in Schools’ mission is to offer mindfulness-based social-emotional education for youth, helping young people to develop compassion, calm, emotional resilience, and self-awareness. Peace in Schools uses images to promote its mission and its programs on behalf of young people.  These materials will not be used for for-profit, commercial purposes of any kind.

Additional Release Agreements

Peace in Schools offers programs at non-school locations.  I understand that I will be solely responsible for arranging transportation for the participant to and from the program site.  I acknowledge that Peace in Schools will be responsible for the participant only during the program and inside the program facility.

 

Peace in Schools also offers programs that include indoor and outdoor activities that may be physically or emotionally demanding. These activities include, but are not limited to, stretching, mindfulness exercises, team building games, walking, running, meditating, group sharing, and discussion. While we encourage all participants to participate in all activities, participating in any of these activities is entirely voluntary at all times.  Peace in Schools will take reasonable precautions to ensure the participant’s safety, including thorough instruction and supervision.  Peace in School instructors are trained to facilitate these outdoor activities and will provide specific safety instructions, which all participants must follow.

 

I give my permission for the participant to participate in Peace in Schools’ activities at non-school locations and/or at occasional outdoor activities.  I affirm that the participant is not under a physician’s care for any undisclosed condition that may endanger the participant or other participants.  I understand that even when reasonable precautions are taken, accidents still can happen.  I acknowledge that outdoor activities have inherent risks that Peace in Schools cannot guard against. I understand and expressly release, discharge and hold harmless Peace in Schools and its employees, officers, directors, staff and volunteers, to the full extent permitted by law, from all liability for any injury, loss or damage (including but not limited to harm caused by defective equipment) connected in any way whatsoever to the participant’s participation in Peace in Schools activities whether on or off school premises.  I understand that this release includes any claims based on negligent action or inaction of Peace in Schools, its staff, employees, officers, directors or volunteers.  I have read and am voluntarily executing this release agreement.

Medical Permission Agreement

I understand that Peace in Schools will make every effort to contact the participant’s emergency number if the participant requires medical assistance.  In the event that the emergency contact is not available, I give Peace in Schools and its employees and staff permission to assume responsibility for securing necessary medical care for the well-being of the participant as long as they are involved in Peace in Schools’ program.  In case of a sudden medical emergency, I give Peace in Schools and its employees and staff permission to secure any necessary medical or surgical care.

 

In the event of a mental health emergency where the participant’s emergency is beyond the scope of our staff support, I give Peace in Schools permission to reach out to their designated on-call mental health support person. Peace in Schools will make an effort to contact the participant’s guardian if on-call mental health support has been utilized. I acknowledge and I understand that Peace in Schools, its employees, and staff are not responsible for any medical expenses incurred, including transportation costs to a medical facility.  I also acknowledge and understand that Peace in Schools and its employees are not responsible for the medical treatment provided by health care professionals.

Execution
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Participant Name
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Parent/Guardian Name if Participant is under 18 years of age
Non-Discrimination Statement

Peace in Schools does not discriminate on the basis of race, color, national origin, gender, sexual orientation, religion, age or disability.