Registration 1 Account Details2 Agreement3 Billing Details Already have account? Login here.Account DetailsPariticpant First Name*Pariticpant Last Name*Participant Email* Pariticipant Phone*Additional DetailsParent/Guardian First Name*Parent/Guardian Last Name*Parent/Guardian Email* Parent/Guardian Cell Phone*Participant Faith Tradition*Gender (optional)Rather not sayFemaleMaleNeutralGrade Entering 2020-2021*7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeHouse of Worship (if any)Participant Town of ResidenceParticipant Date of Birth* Date Format: MM slash DD slash YYYY Where did you hear about Kids4Peace Boston? (optional)Which program would you like to sign up for?*K4PB@Home Course Youth Permission and Waiver - Viual ProgrammingTHIS FORM MUST BE COMPLETED BY ONE CUSTODIAL PARENT/GUARDIAN OF THE CHILD. If multiple children in the household are participating in Kids4Peace Boston programming during the 2020-2021 school year, separate forms must be filled out for each child who will participate. 1) I, the undersigned parent/legal guardian of the above youth participant (the “Participant”) hereby acknowledge that I understand that I have been offered to have the Participant participate in a children’s online program (the “Program”) operated by Kids4Peace Boston (the "Organization”). I understand that in this Form the Organization includes the staff, board members, and volunteers. 2) Activities and Risks ACTIVITIES: Program activities may include, but are not necessarily limited to: Online community and team-building activities, both live and pre-recorded, using internet platforms approved by the Organization. Viewing of online content including instructional videos and slides. At home activities: the participant may be invited to undertake activities on their own time, such as, but not limited to, online research, meeting with community leaders, project planning, advocacy, letter writing, lobbying, service projects that can be safely done during COVID-19. RISKS: While the Organization takes every security precaution before, during, and after all online programming, the Participant’s participation in the Program, including each of the activities offered as part of the Program involves a level of risk. All risks cannot be listed on this form but may include, data mining, phishing, viruses, malware, data breach of online information, cyberbullying, exploitation, victimization, cyber stalking, online grooming, cyber predators...etc.. Many of these risks are inherent in any use of the Internet. Any additional risk of damage to equipment including but not limited to smartphone, computers, etc. is the sole responsibility of the owner of said equipment. Participation in the Program is at the Participant’s own risk. 3) PARENT/GUARDIAN CONSENT and WAIVER: I consent to the Participant’s participation in the Program with the knowledge of the risks involved. I accept any and all risks, including the risk of injury or death and/or damage to or loss of property associated with the Participant’s participation in the Program. I hereby agree to waive any and all liability of the Organization, and agree that I will completely indemnify and hold harmless the staff, board, and volunteers of the Organization from any legal action, including any class actions, associated with injury to my child or injuries to property, except in the case of gross negligence. 4) CONTACT SHARING PERMISSION: I the undersigned give permission for the Organization staff to share my contact information and my child's contact information (phone number and email address) with other Organization participants and parents/guardians for the purposes of helping Organization participants connect with one another and work collaboratively. 5) MEDIA RELEASE: I the undersigned give our permission for, and acknowledge the right of the Organization staff and hired and/or volunteer staff to photograph, videotape, audiotape and otherwise record ourselves and my child or children during all Program activities, and to use this and all other documentary material at the discretion of the Organization staff for documentation, publication and promotion (online and in print) according to the Kids4Peace Boston Media and Publicity Guidelines. I waive all my own rights and claims, if any such exist, to the above photographic, videotape or audiotape or any other form of documentary material obtained for or produced by the Organization for the purposes of Organization programs. Media agreement*I DO consent to this media policyI do NOT consent to this media policySignature*Date* Date Format: MM slash DD slash YYYY Billing DetailsBilling Name First Last Billing Email* Total $0.00 Coupon I have a coupon Coupon Total: $0.00 Credit Card Card Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.