STREAM~N Team Application and Waiver Form

Given Full Name of Youth Applicant (required)

Name the Youth Uses (if different)

Full Name of Parent or Guardian (required)

Relationship to Youth Participant (required)

Home Address (required)

City, State (required)

Parent/Guardian Email Address (required)

Confirm Parent/Guardian Email Address (required)

Youth Email Address

Confirm Youth Email Address

Parent Phone Number (required)

Youth Phone Number (helpful)

Birth Month, Day and Year of Applicant (required)

Youth Gender Pronouns (helpful: he/him, she/her, they/them, etc.)

T-shirt Size (required: Small Men's, Medium Women's, XXL Men's, etc. )

Other adults authorized to pick up the participant and their phone numbers (if applicable):

Questions for youth participants:

1. Have you participated in other volunteer and/or work experiences? If so, please tell us about them and what you learned from each experience. If you have not worked or volunteered much before, what do you think may have been holding you back?

2. Which role(s) explained on the About page sound enjoyable/interesting to you? Check all that apply.
Biodiversity WarriorBuilderCartographerPhotographerCommunications SpecialistEthnobotanistGuide / MentorHealth + Safety OfficerTeam CaptainCrew LeaderWater Quality SpecialistWildlife Researcher

3. What do you hope to gain by joining the STREAM~N Team?

4. What classes, teachers, and/or activities have gotten you most excited about learning or trying something new? What do you like about them?

5. Do you have ideas about possible careers or education programs you might pursue in the future? If so, please tell us about them and why they interest you. If not, please research any career or education program, such as nursing, construction or website design and tell us what sounds interesting and/or challenging about it.

Important Information for Parents/Guardians and Youth Participants:

STREAM~N Team programs are led by veteran educators with decades of experience who will keep participants safe and engaged, including Rick Reynolds, M.S.Ed., Founder of Engaging Every Student. That said, we need you to read and sign this waiver and release to be able to offer the program. Please read it carefully before signing.

I am the parent or legal guardian of Participant named below and I, the undersigned, enter this Release and Waiver of liability and Assumption of Risk Agreement (“Agreement”) on behalf of myself, the Participant, my personal representatives, next of kin, heirs, successors, and assigns and anyone else who may make any claim for or on behalf of the Participant.

• I will require the Participant to agree and comply with the terms of the Agreement and not to take any actions that would assist or cause the Participant to invalidate, renounce, negate, revoke, or disclaim any part of the Agreement.

• I make this Agreement for the benefit of partner organizations, other Participants, program coordinators, sponsors, suppliers, supporters, and all private and public parties whose property the program described above may be located (collectively the “Released Parties"), including, without limitation, the Released Parties’ employees, agents, personal representatives, next of kin, heirs, successors and assigns.

• I make this Agreement in consideration of the Released Parties providing Participant with the opportunity to participate in this program.

• Participant and I accept full personal responsibility for all risks arising from or relating to this program.

• Participant will read, listen to and follow all safety instructions and procedures presented in conjunction with this program and use best judgment based upon physical and mental abilities at all times, and to immediately terminate participation in this program if activities become too strenuous, difficult or hazardous.

• I agree to waive all liability of the Released Parties, discharge them, and covenant not to sue them for any liability, claims, sums, costs, or other expenses on my account that may be caused in whole or in part by Participant’s involvement in the program.

• I agree that this Agreement shall act as a complete bar against all actions or claims that I might otherwise bring against the Released Parties, including negligence claims, arising from or related to this program.

• I have read this Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature. I intend this Agreement to be a complete and unconditional release of all liability to the greatest extent allowed by law, and I further agree that if any portion of this Agreement is held invalid, then the balance of the Agreement shall continue in full force and effect.

• I understand that a photographer may be present to photograph the activities of the program and that Participant may be photographed while participating in it. I agree that I will email Rick Reynolds at rick@engagingeverystudent.com if Participant does not wish to be photographed.

• I hereby grant the irrevocable and unrestricted right to use and publish photographs of Participant, or in which Participant may be included. Unless I contact Rick Reynolds to ask that photographs of Participant not be used, I hereby release Photographer and their legal representatives and assigns and partner organizations from all claims and liability relating to any such photographs.

Please check this box to agree to the terms of this Youth Permission and Waiver Form.

Parent or Guardian: Please type your legal name below to serve as your signature on this agreement.

Youth Participant: Please type your legal name below to serve as your signature on this agreement.

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