Banisters Leadership Academy

Thank you for your interest in joining us for our summer program, the y2M Project. Please complete this 2 page assessment as it is part of the application process, and we will follow up with you once they are completed and a choice has been made.
Due to a high volume of applicants, spots are not guaranteed.

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* 1. What is your first and last name? (parent/guardian)

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* 2. Please list all of your children's names that you would like to sign up for our summer program?

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* 3. What is your zip code?

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* 4. Do you give permission to your youth to join Banisters Leadership Academy for its summer program known as y2M?

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* 5. For your child to get a full program experience, do you consent to your child joining Banisters Leadership Academy for field trips, to be transported by staff, and consent to a photo release? (Meaning staff can take pictures of him/her for program purposes.)

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* 6. Covid-19 Release:
ACKNOWLEDGMENT AND ASSUMPTION OF RISK
The COVID-19 coronavirus has been declared a worldwide pandemic by the World Health Organization, is extremely contagious and is believed to spread mainly from person-to-person contact. By signing this, you ACKNOWLEDGE AND ASSUME THE RISK AND DANGERS OF ILLNESS, DISEASE, MEDICAL COMPLICATIONS, INJURY OR DEATH, caused by or related to COVID-19, by voluntarily entering the property and/or public facilities of any Municipality and participating in or viewing adult and/or youth games, practices, or other recreational activities, or by authorizing the participation of a minor in or the presence of a minor at such games, practices, or other recreational activities. No one guarantees that you or your child(ren) will not become infected with COVID-19. The person signing below voluntarily assumes this risk because s/he chooses or elects to do so.

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* 7. COVID-19 RELEASE AND INDEMNITY AGREEMENT AND COVENANT NOT TO SUE
In consideration of the above-listed player, coach, or official (“Participant”) being allowed to participate in adult and/or youth team sports or other recreational activities on municipal property and/or public facilities, the Participant or the parent(s) or legal guardian (if Participant is a Minor), on his or her own behalf and on behalf of any Minor Participant, agree as follows:

1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, AND FOREVER DISCHARGES ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST THE BANISTER'S LEADERSHIP ACADEMY ("BLA") AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE "RELEASED PARTIES"), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT, OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH THE UNDERSIGNED, ITS HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON THE UNDERSIGNED'S BEHALF, WHICH ARISES OR MAY HEREAFTER ARISE FROM THE UNDERSIGNED'S PARTICIPATION WITH THE ACTIVITY. THE FOREGOING SHALL INCLUDE, BUT NOT BE LIMITED TO, ANY DAMAGES RELATED TO COVID-19.

2. THE PERSON(S) SIGNING BELOW AGREE(S)TO INDEMNIFY, DEFEND, AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from any liability, damage or loss (including, but not limited to, attorneys’ fees and other defense costs) one or more of them may suffer or incur arising out of or related to the Participant’s or any of the undersigned’s entry onto the property and/or public facilities of any such Municipality in connection with any game, practice, or other recreational activity, whether such claim is based on one or more of the Releasees' negligence, breach of contract or warranty, strict liability or other legal theory. The undersigned COVENANTS not to sue any Releasee related to injury, disease, loss, quarantine, or illness related to COVID-19.

3. THE PERSON(S) SIGNING BELOW AGREE(S) to comply with all federal, state and local laws and regulations, all directed health measures and guidelines, and all security policies or procedures established by any such Municipality relating to COVID-19 or other safety or hygiene precautions, understanding that the Municipality may elect to deny entrance to the property (including any facilities present thereon) and the Participant may not be allowed to participate or continue to participate in the game, practice, or other recreational activity at the election of the Municipality at any time. The undersigned agree(s) that in the event any portion of this document is held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect to the greatest extent possible under applicable law. The parents or guardian of the Participant agree that by signing below they are binding themselves and binding any minor Participant on whose behalf they have signed, to the maximum extent permitted by applicable law to this Agreement in full.

*I AM THE AGE OF MAJORITY, AM COMPETENT AND HAVE FULL AUTHORITY TO SIGN THIS, HAVE READ THE ABOVE AND UNDERSTAND ITS TERMS. I SIGN KNOWING ITS EFFECTS.

Please enter the Name of Parent or Legal Guardian below to consent to an electronic signature.

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* 8. Emergency Contact Name:

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* 9. Emergency Contact Phone Number:

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* 10. Please enter today's date:

Date

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* 11. By typing your name below, you are agreeing to all of the above statements and consenting to an electronic signature.

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