Dear YES Family, 

You and your family are invited to join us at a YES Nature Day Outing which will take place on October 7, 2023 at Point Pinole Regional Shoreline, located at 5551 Giant Hwy, Richmond, CA 94806 from 10:00 am - 2:30 pm. 

Activities will include birding, hikes, fun games, cycling, learning, and much more! Lunch and snacks will be provided. 

If you are interested in attending this event, please fill out this form.

We hope you can join us!

~The YES Team
 
 

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* 1. Parent or Legal Guardian's Information

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* 2. In case of an emergency, please list at least one person who will be available to support you, and/or your child(ren).

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* 3. Permission to photograph and videotape: YES Nature to Neighborhoods is a nonprofit organization. Program activities may be photographed, filmed, and/or audio recorded for educational, publicity, or fundraising purposes. Please indicate if you will allow your child(ren) to appear in recordings, videos, and/or photos without compensation (e.g., as part of brochures, slide shows or program websites).

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* 4. ACKNOWLEDGEMENT OF YES PROGRAM POLICIES: During YES Programs, the use, possession or distribution of ALCOHOL, CANNABIS, OR ANY ILLEGAL SUBSTANCES ARE PROHIBITED. PLEASE DO NOT BRING OR BRANDISH ANY WEAPONS. WE DO NOT TOLERATE ANY VERBAL, PHYSICAL OR MENTAL ABUSE, NOR ANY VERBAL OR PHYSICAL FIGHTS OR  ILLEGAL BEHAVIOR. Individuals who do not respect these policies will be removed from YES Programming immediately.

I affirm that I am the parent or legal guardian of the child(ren) listed in this application. I have read, understand, and acknowledge that by signing below, I accept the terms and conditions stated in this Acknowledgement of YES Program Policies and acknowledge that if I,  my child(ren), or any member of my family engage(s) in any of the above during YES Programs, we will be asked to leave the program immediately, and that I will need to arrange for the transportation that will pick me, my child(ren), and other family members from this Activity.

First & Last Name of Parent or Legal Guardian:

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* 5. For each person that you are signing up, please list the
  • names
  • ages
  • medical, physical conditions
  • dietary restrictions (vegetarian, no pork, lactose intolerant, etc.)
  • allergies (peanut, shell fish allergies, etc) 

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* 6. I, the undersigned, as participant, or as parent or legal guardian of the child(ren) listed in this form, hereby assume full responsibility for all risk or injury or loss which may result from my or my child(ren)'s participation in this Activity, and give permission for my child(ren) to participate in this Activity. I hereby agree to hold harmless, release and forever discharge YES Nature to Neighborhoods (YES), its officers, directors, agents, and employees and its partners and their representatives from any and all claims and demands whatsoever which the undersigned, and any of them or any third party and their representatives or any person acting under their behalf have, or may have against YES and/or its partners by reason of any accident, illness, injury, or death to any person or persons, or damage to, loss of or destruction of property arising or resulting directly or indirectly from my or my child(ren)'s participation in this activity, and occuring during said participation or anytime subsequent there to regardless of whether said claims or demands arise out of negligence on the part of YES or its partners. The terms of this release shall serve as a release and assumption of risk for myself, my child(ren), heirs, executives, administrators, and for all of my family members. I understand, agree, and acknowledge that some activities in this program may be of a hazzardous nature and/or include physical and/or strenuous activity. I hereby assume all risk of such activities. Understanding this, I state to the best of my knowledge that I or my child(ren) listed on this form have no medical, physical, mental, or emotional health conditions which would hinder my or my child(ren)'s active participation in this Activity. In case of an emergency in which I am not able to give permission for medical treatment and my designated emergency contact cannot be reached, I authorize YES or its partners to obtain whatever medical treatment is deemed necessary for my or my child's welfare. In the case of my child, this authorization is given pursuant to the provision of Section 25.8 of the Civil Code of California. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether my medical insurance would cover such charges and fees. 

First & Last Name of Parent or Legal Guardian:

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