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New Youth Form

Welcome to one·n·ten!

All youth must complete the following form to attend one·n·ten programs.
You only need to fill out the form once, unless instructed otherwise by staff.

Questions? Please email wallace@onenten.org

Contact Information

Please use current name when signing into one·n·ten programs, and let us know if your current name changes.


This is for internal use only and will not be shared publicly

Or other names you have gone by

You will need to provide one·n·ten with a photo ID (below) verifying age in order to participate. If you do not have a photo ID, contact a staff member

Age 11-17: Upload driver's license, state ID, or school ID
Age 18+: Upload driver's license, state ID, or any ID with photo and birthdate
 If you do not have a photo ID, contact a staff member



If today is your first day at one·n·ten, put today's date





one·n·ten will only reach out in emergencies
Emergency Contact Information (If you are 17 and younger, list legal guardian)
Please note: If we need to contact your emergency contact, we will state our organization's name -- one·n·ten.







Address Information






Identity


2gether N Color group meets on the 1st and 3rd Thursday at the Phoenix Youth Center.
Text @qoconenten to 81010 for more info.






Trans and Gender Non-Conforming group meets at the Phoenix Youth Center every 2nd and 4th Thursday.
Text @tgnonenten to 81010 for more info.


Are you out to:
Yes No Somewhat
Personal Information
Please answer these next questions so we can best help you with resources and support.

If you do not know your status, contact logan@onenten.org for testing info



one·n·ten Information




Housing Information

If you are currently experiencing homelessness, contact keri@onenten.org for resources






If you do not know, please give your best guess

School/Employment Information






Health Information




11-13 Year Old Permission Form

I agree to allow my minor child to attend one·n·ten programs. This includes (but is not limited to) the Youth Center, state-wide satellite groups, and special events. I understand that the programming at one·n·ten is typically made for an audience between the ages of 14-24. I also understand that if the programming is inappropriate for youth between the ages of 11-13, the program will be further age restricted. I understand that if my minor child is attending in-person one·n·ten programs, I will arrange transportation for my minor child to and from one·n·ten locations. 
Agreement


If youth participant is 11-13 years old: Signatory must be legal guardian.

If youth participant is 11-13 years old: Signatory must be legal guardian.

Participant Agreement

Program Rules:
  1. Participants must abide by the age restrictions of each site
  2. Participants must enter/exit thru the designated entrance/exit
  3. Participants must be in staffed areas only and must sign in
  4. Smoking and/or vaping is not allowed on the property
  5. Participants who appear to be inebriated will not be admitted
  6. Personal safety weapons MUST be checked in with staff
  7. Firearms and large knives are never permitted
  8. Food only to be eaten in designated areas
  9. one·n·ten staff are not responsible for stolen items
  10. Disrespectful language or unsafe behaviors are not tolerated
  11. Youth must participate if they choose to stay for group
  12. No sleeping at any programs or at the downtown Youth Center
  13. Participants must adhere to all Safe Space guidelines
  14. Participants will receive two verbal warnings before being asked to leave for the evening or indefinitely
  15. No one with a record of sex offences or violent felonies is allowed to participate in any one·n·ten program
Behavior not allowed at one·n·ten includes, but is not limited to, the following and may result in disciplinary action: 
  1. Swearing directly to peers, volunteers or staff  
  2. Threatening language or behaviors/hate speech 
  3. Aggressive body language  
  4. Inappropriate sexual language or gestures  
  5. Escalating out of control and refusing to discuss with staff 
  6. Not responding to staff direction or accepting of consequences  
  7. A progressive refusal to display respectful behavior/language 
  8. Bullying of others 
  9. Not adhering to any of the safe space guidelines or rules 
  10. Assault  
  11. Threatening; breach of peace  
  12. Destruction of property  
  13. Theft 
  14. Vandalism  
  15. Possession, consumption, or sale of drugs/alcohol  
  16. Sexual solicitation 
  17. Possession of unauthorized weapons 
  18. Harm to self or others
Agreement
I have read and fully understand the one-n-ten youth handbook, and I (or my minor child) agree to abide by the above rules and guidelines. I (or my minor child) understand that if the above rules and guidelines are not adhered to, the following may occur: Immediate removal from premises and programs, notification to law enforcement, crisis agency, Child Protective Services, etc., suspension/expulsion from programs, or additional consequences as determined by one-n-ten staff.


If youth participant is 11-13 years old: Signatory must be legal guardian.
If youth participant is 14-24 years old: Signatory can be youth participant.

Computer & Internet Policy

At the downtown Phoenix Youth Center, we have computers available for youth participant use. The computers are recognized as a valuable educational resource, which if used appropriately can contribute to the personal and social development of youth participants. Onenten believes that young people should have the opportunity to access these resources to support their learning. However, the internet also contains materials of potentially offensive nature, and if not managed effectively can cause harm to participants, staff, volunteers and others. We will take all reasonable measures to ensure that this resource is used to its fullest potential and prevent any inappropriate access. Using the computers is a privilege that may be taken away should you fail to abide by the following computer use and internet policy:

- No food or beverage is allowed while using the computers
- You must clean up after yourself: Please sign out, turn your computer off properly, and make sure the workspace is clean for the next user
- You may only access Onenten approved sites on the Onenten computers. Adult websites and dating sites and strictly prohibited
- Downloading and installing software, images or making other changes to the computers is strictly prohibited
- Online bullying of others is strictly prohibited and will be taken very seriously should it occur
- NEVER post personal information on the internet (address, telephone number, age, birthday, social security number, school name etc.)
- If you are accessing a website with sound, headphones must be worn. Please hand headphones to staff after use
- The youth center reserves the right to monitor history and work stored on the computers and members on computers must be supervised
- Participants may only access the internet if they have obtained prior permission from the staff during scheduled computer time
- The computer lab and internet ma only be used under the supervision of a member of staff or volunteer, without exception
- Material, which is in anyway offensive, must not be accessed or sent through the internet in any for whatsoever
- Live chat rooms are prohibited. There are no exceptions to this rule
- A member of staff must be informed immediately if any inappropriate or offensive material appears on the computer
Agreement


If youth participant is 11-13 years old: Signatory must be legal guardian.
If youth participant is 14-24 years old: Signatory can be youth participant.

Digital Space Permission Form

I (or my minor child) agree to abide by the Digital Space Rules while attending any one•n•ten digital programs - on either Zoom, Twitch, Minecraft, and/or Discord platforms. I understand that each of these platforms has text capabilities that will allow the me (or my minor child) to message with other Youth Participants and one•n•ten staff and volunteers. I understand that the Zoom and Discord platforms have video and audio capabilities that will allow me (or my minor child) to view and hear other Youth Participants, staff, special guests, and volunteers, as well as speak to and be seen by other Youth Participants, staff, special guests, and volunteers. I hold one•n•ten harmless from any offensive images, language, or liabilities arising out of participation in one•n•ten's digital platforms.

Digital Space Rules:

1. Youth Participants must abide by the age restrictions of all one•n•ten's program.
2. Smoking and/or vaping on camera is not allowed
3. Youth Participants who appear to be under the influence will be removed from the group for the day
4. Disrespectful language or unsafe behaviors are not tolerated
5. Participants must adhere to all Digital Safe Space guidelines
6. Participants will receive two verbal warnings before being asked to leave for the evening or indefinitely

Serious inappropriate behaviors include, but are not limited to:

1. Swearing directly to peers, volunteers, staff, or guest speakers.
2. Threatening language or behaviors/hate speech
3. Aggressive body language
4. Inappropriate sexual language or gestures
5. Escalating out of control and refusing to discuss with staff
6. No responding to staff direction or accepting of consequences
7. A progressive refusal to display respectful behavior/language
8. Bullying of others
9. Not adhering to any of the Safe Space Guidelines or one•n•ten's Digital Space rules

Illegal behaviors include, but are not limited to:

1. Assault
2. Threatening; breach of peace
3. Possession, consumption, or sale of drugs/alcohol
4. Sexual solicitation
5. Harm to self or others
Agreement


If youth participant is 11-13 years old: Signatory must be legal guardian.
If youth participant is 14-24 years old: Signatory can be youth participant.

Consent to Medical Treatment & Release of Liability

I, or my minor child (herein known as a one•n•ten Youth Participant), often accesses social, educational, and other services at the Youth Center/Satellite Group or while on a field trip to the park, downtown art museums or other public or private venues or spaces. In consideration of being allowed to participate, I hereby release the sponsoring organizations, the host organization and facility, their boards, officers, employees, and volunteers (herein known as one•n•ten Staff) from any and all liability, claims, demands, or course of action whatsoever arising out of relating to any loss, damage, or injury, including death, that may be sustained by me/my child, or any property belonging to me/my child, whether caused by the negligence of the one•n•ten Staff or otherwise while in, on , or upon the premises where the event(s) is being conducted.

To the best of my knowledge, I/my child is in good physical and mental condition and I am not aware of any physical or mental infirmity that would place me/my child at risk to participate in any way in one•n•ten activities. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury, including death, that may be sustained be me/my child, or any loss or damage to property owned by me/my child, as a result of being engaged in one•n•ten programs, whether caused by the negligence of the one•n•ten Staff or otherwise. I further hereby agree to indemnify and hold harmless the one•n•ten Staff from any loss, liability, damage or cost, including court costs and attorney's fees, that may accrue related related to me/my child's participation in one•n•ten programs, whether caused by the negligence of the one•n•ten Staff or otherwise. During the period of any participation of one•n•ten programs, I hereby give permission for the one•n•ten Staff to administer appropriate first aid and authorize any medical attention or emergency treatment deemed necessary for me/my child in the event of an accident, illness, or injury. I will be responsible for any and all costs of medical coverage and treatment provided not covered by personal insurance.

It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the member of my family and spouse/partner. If I am alive, and my heirs, assigns, and personal representative, if I am deceased, and shall be deemed as a release waiver, discharge and covenant not to sue the one•n•ten Staff or agency. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Arizona. In signing this release, I acknowledge and represent that I have carefully read this document and fully understand the contents, meaning and impact of the agreement; I sign this document freely and voluntarily without any inducement; I am at least 18 years of age and fully competent; and I execute this release for full, adequate, and complete consideration, fully intending to be bound by the same.
Agreement


If youth participant is 11-13 years old: Signatory must be legal guardian.
If youth participant is 14-24 years old: Signatory can be youth participant.

Photo Release Form

I or my minor child (herein known as one•n•ten Youth Participant) is an active participant of the one•n•ten Youth Center (or Satellite location), a social component youth services of one•n•ten, Inc. I hereby grant one•n•ten, Inc. and one•n•ten staff permission to use my/my child's likeness in a photograph or video in any and all of their publications and promotional materials, including internet and website entries, without payment or any other consideration. I understand and agree that these materials will become the property of one•n•ten, Inc. and will not be returned.

I hereby irrevocably authorize the one•n•ten, Inc. to edit, alter, copy, exhibit, publish, or distribute these photos or videos for purposes of publicizing one•n•ten programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising from or related to the use of the photographs or videos. I hereby hold harmless and release and forever discharge the one•n•ten from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I agree to indemnify and hold the one•n•ten harmless for any and all losses, claims, expenses, suits, costs, demands and damages, or liabilities arising out of the photographed or videotaped activities.
Agreement


If youth participant is 11-13 years old: Signatory must be legal guardian.
If youth participant is 14-24 years old: Signatory can be youth participant.