Strong Fast Fit Interest Form

Strong Fast Fit

SFF program will resume in January 2024.

Submit this Interest Form for youth to participate in Strong Fast Fit during the 2023-2024 school year.

Location: YWCA Midtown, 2121 East Lake Street, Minneapolis, Room 155/156

Questions? Email strongfastfit@ywcampls.org or call 612-215-4373.

About Strong Fast Fit

Step 1 of 4

Family Information
How would your child(ren) get to and from YWCA Midtown for the program?*
- Drop off/pick up
- Biking/walking
- Metro Transit/taxi/ride-share service
Language(s) spoken at home:*
Is your family eligible for free or reduced price lunch at your school?*
We realize there can be other challenges a family may be encountering that impacts their household income. Is there anything you would like us to know about your family’s situation?
Parent/Guardian Information
Parent/Guardian Name*
First Last
Parent/Guardian Email*
Relationship to Child(ren)*
Parent/Guardian Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Emergency Contact
Emergency Contact Name*
First Last
Emergency Contact Phone*
Relationship to Child(ren)*

Parent/Guardian Consent
1. I grant permission for my child/ward: - To participate in all activities of YWCA youth programs - To participate in program field trips under proper supervision - To ride in authorized YWCA vehicles for program activities - For the YWCA Youth Program Counselor to obtain information on my child’s/ward’s academic and attendance records 2. I understand that programs may contain information on sexuality and other health-related issues and I give my child/ward permission to participate. 3. I agree that neither YWCA nor any other person associated with them has any responsibility to me or to my child/ward for any claims arising from accident, health or medical treatment. 4. I understand that any expenses incurred under item 3 will be the sole responsibility of the child’s/ward’s family. 5. I understand that YWCA staff and volunteers are Mandated Reporters. If abuse or neglect is suspected, YWCA staff and volunteers are required by Minnesota law and YWCA policies to place a report to Child Protection Services. 6. I hereby authorize YWCA staff to give my child/ward reasonable first aid and to transport my child/ward to a health care facility for emergency services as needed. I have read the above terms and agree to them while my child/ward is a participant in YWCA Minneapolis youth programs. 7. Attendance and participation are crucial to the success of the Strong Fast Fit program. As parent(s)/guardian(s), we are/I am committed to actively participate in this program until the end. Participation in 75% of the program is required to receive the free family fitness membership.*
I agree to the following statements.
1. I grant permission for my child/ward:
- To participate in all activities of YWCA youth programs
- To participate in program field trips under proper supervision
- To ride in authorized YWCA vehicles for program activities
- For the YWCA Youth Program Counselor to obtain information on my child’s/ward’s academic and attendance records

2. I understand that programs may contain information on sexuality and other health-related issues and I give my child/ward permission to participate.

3. I agree that neither YWCA nor any other person associated with them has any responsibility to me or to my
child/ward for any claims arising from accident, health or medical treatment.

4. I understand that any expenses incurred under item 3 will be the sole responsibility of the child’s/ward’s family.

5. I understand that YWCA staff and volunteers are Mandated Reporters. If abuse or neglect is suspected, YWCA staff
and volunteers are required by Minnesota law and YWCA policies to place a report to Child Protection Services.

6. I hereby authorize YWCA staff to give my child/ward reasonable first aid and to transport my child/ward to a health care facility for emergency services as needed. I have read the above terms and agree to them while my child/ward is a participant in YWCA Minneapolis youth programs.

7. Attendance and participation are crucial to the success of the Strong Fast Fit program. As parent(s)/guardian(s), we are/I am committed to actively participate in this program until the end. Participation in 75% of the program is required to receive the free family fitness membership.
By typing my full name in the box below, I consent to the above. This is equivalent to my signature.*
Date*

Publicity Consent
- Make video and audio recordings of me and/or my voice. - Take and use photographs of me and/or my family. - Record, use, display and disclose in a video and/or other media intended for public consumption statements and/or information provided by me concerning myself and/or my family. - Use the activities listed above for direct mail, advertising, public relations, website, email, social media (e.g., Facebook, Twitter, etc.) and other online efforts related to the YWCA of Minneapolis. - Use my name and the names of members of my family in conjunction with the activities listed above. With respect to the above, I relinquish to the YWCA of Minneapolis all rights, title and interest I may have in all originals, edited versions, reproductions, and copies of any video and/or audio recording(s), prints, negatives, digital images and photographs in which my or members my family’s name, image, statements, information, and/or voice is used (the “Materials”). I also irrevocably grant the YWCA of Minneapolis permission to copyright, if applicable, the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the Materials in any manner and for any reason the YWCA of Minneapolis may deem proper, including the right to use the same for purposes of advertising or trade. By signing this Publicity Consent Release, I acknowledge that the YWCA of Minneapolis is not responsible for the unauthorized use of the Materials by unrelated third parties. I hereby release the YWCA of Minneapolis from liability for any damages that may arise from the unauthorized use of the Materials by a third party. NOTE: If you should no longer like the YWCA of Minneapolis to use your image in its awareness and education materials and activities, please contact the YWCA of Minneapolis. Due to the distribution and printing timelines, some of the materials the YWCA of Minneapolis may not be able to remove your image immediately from its pieces, but will do so as soon as those print pieces are scheduled for reprinting or new production. Print materials that are distributed to public audiences may not be recalled once distributed. Materials used for emails, website, social media or other online efforts may be removed from YWCA sites and networks, but due to the nature of the internet, may remain available online through other sources indefinitely.
I hereby grant voluntarily and without monetary compensation the YWCA of Minneapolis permission to:
- Make video and audio recordings of me and/or my voice.
- Take and use photographs of me and/or my family.
- Record, use, display and disclose in a video and/or other media intended for public consumption statements and/or information provided by me concerning myself and/or my family.
- Use the activities listed above for direct mail, advertising, public relations, website, email, social media (e.g., Facebook, Twitter, etc.) and other online efforts related to the YWCA of Minneapolis.
- Use my name and the names of members of my family in conjunction with the activities listed above.

With respect to the above, I relinquish to the YWCA of Minneapolis all rights, title and interest I may have in all originals, edited versions, reproductions, and copies of any video and/or audio recording(s), prints, negatives, digital images and photographs in which my or members my family’s name, image, statements, information, and/or voice is used (the “Materials”).

I also irrevocably grant the YWCA of Minneapolis permission to copyright, if applicable, the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the Materials in any manner and for any reason the YWCA of Minneapolis may deem proper, including the right to use the same for purposes of advertising or trade.

By signing this Publicity Consent Release, I acknowledge that the YWCA of Minneapolis is not responsible for the
unauthorized use of the Materials by unrelated third parties. I hereby release the YWCA of Minneapolis from liability for any damages that may arise from the unauthorized use of the Materials by a third party.

NOTE: If you should no longer like the YWCA of Minneapolis to use your image in its awareness and education materials and activities, please contact the YWCA of Minneapolis. Due to the distribution and printing timelines, some of the materials the YWCA of Minneapolis may not be able to remove your image immediately from its pieces, but will do so as soon as those print pieces are scheduled for reprinting or new production. Print materials that are distributed to public audiences may not be recalled once distributed. Materials used for emails, website, social media or other online efforts may be removed from YWCA sites and networks, but due to the nature of the internet, may remain available online through other sources indefinitely.
Name of Minor Child
By typing my full name in the box below, I consent to the above for the child listed. This is equivalent to my signature.
Date

Strong Fast Fit Interest Form

Strong Fast Fit Interest Form

Strong Fast Fit

Step 1 of 4

Student Information

Child #1 Information

Child #2 Information

Child #3 Information

Family Information

Parent/Guardian Information

Emergency Contact

Parent/Guardian Consent

Publicity Consent