Artmaking and Video Storytelling - Activity Consent Form

The following form is required for youth to participate in this official one∙n∙ten activity.
Youth ages 11-17: Please have your parent/guardian complete the form
Youth ages 18-24: Please complete this form yourself
Program Name: Phoenix Art Museum - art making  & video story telling
Location: meet at Youth Center 4pm 
Transportation: Light Rail
Departure & Return date/Time: 9/18/25 4:30-7pm
Contact person(s) for the activity: Abby or Logan
Consent form due by date: 9/17/25
Youth Info




Details on meet up spot, time & length of
program will be sent to this email.

Guardian Information




Medical Information



Emergency Contact






In consideration of being allowed to participate in one∙n∙ten activities, I hereby release the sponsoring organizations, 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 or relating to any loss, damage, or injury, including death, that may be sustained by me/my child, or to any property belonging to me, whether caused by the negligence of the one∙n∙ten Staff or otherwise, while participating in this program, or while in, on, or upon the premises where the program is being conducted. 

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.

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 which would place me at risk to participate in any way in program activities, including those that are outdoors. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in the program activities, 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 to my participation in this program, whether caused by the negligence of the one∙n∙ten Staff or otherwise.

During the period of the program, I hereby give permission for the one∙n∙ten Staff to administer appropriate first aid (including over-the-counter medicines) and to 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.

*OUTscouts programs may include rock climbing. I am fully aware of the risks and hazards connected with indoor rock climbing.

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
Photo Release

Consent

Youth ages 11-17: Please have your parent/guardian sign on the next page. Parental/guardian signature will be verified by staff. 
Youth ages 18-24: Please sign yourself on the next page