Skip survey header

City of Salem - Youth Development - Our Salem Registration

City of Salem – Youth Development Registration
Gen Z Forum: Our Salem Focus Groups 2021 - April 24, 26, and 29, 2021

REGISTRATION PACKET (Including ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY)
Virtual 1-Hour Event

Complete by April 23, 2021
1. Which 1-hour session do you want to attend?
2. Would you like a certificate of participation when the focus group is complete? *This question is required.
3. Contact information *This question is required.
This question requires a valid number format.
This question requires a valid email address.
10. In case of emergency during virtual event, contact *This question is required.
11. In case of emergency during virtual event, also contact
EXPECTATIONS of Youth Development Events and Programs:
1.  Abstain from the use of tobacco, alcohol and other drugs.
2.  Be courteous and respect the rights of others.
3.  Attend and actively participate in all scheduled activities.
4.  Follow all other rules and guidelines deemed necessary by event staff.

Our Salem Focus Group Sessions 2021
ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY

With full knowledge of the facts and circumstances surrounding the Gen Z Forum: Our Salem Focus Group 2021 Activities:
  1. I voluntarily participate in the Gen Z Forum: Our Salem Focus Groups 2021 activities (now referred to as “ACTIVITIES”), agree to follow the rules of the ACTIVITIES, and understand my responsibilities and risks resulting from my participation, including all risk of economic injuries, income loss, property damage, physical injury and death to myself and to others. I understand that I am solely responsible for any medical costs that may directly or indirectly result from my participation in the ACTIVITIES.
  2. I am aware the ACTIVITIES involve certain inherent risks, and that economic injuries, income loss, physical injuries, death, and property damage may occur regardless of precautions taken by the City of Salem or the participants. I understand and agree that the City of Salem, its officers, employees, agents, and volunteers, assume no liability or responsibility for economic injuries, income loss, physical injury, death, or property damage that I may sustain as a result of participation in the ACTIVITIES.
  3. I have reviewed all information regarding the Gen Z Forum: Our Salem Focus Groups 2021 events, including but not limited to: the EXPECTATIONS of Youth Development Events and Programs list located above, event informational flier found at https://www.cityofsalem.net/CityDocuments/our-salem-gen-z-focus-group.pdf, and this Acknowledgement of Risk and Waiver of Liability.
  4. PHOTOGRAPHY, FILM, USE OF AIRMEET APPLICATION:
    1. I understand that the ACTIVITIES, will occur as an “on-line” event through the “AIRMEET” application. AIRMEET is a third-party application that is not owned or controlled by the City of Salem.
    2. I understand and agree that it is my responsibility to become familiar with and follow all “terms of service,” “terms of use,” and any other conditions imposed by AIRMEET (AIRMEET Inc.) and its affiliates, in connection with my use of AIRMEET as part of my participation in the ACTIVITIES.
    3. I understand that the ACTIVITIES will be audio and video recorded. By participating in the ACTIVITIES I authorize the City of Salem to record my participation and appearance in the ACTIVITIES on any recorded medium including, but not limited to video, audio, photos (collectively “recordings”) for use in any form (including, but not limited to print, websites, blogs, internet, social media, video-calls). I authorize such recording and authorize the City of Salem to use my name, likeness, voice, and biographical material to exhibit or distribute such recordings in whole or in part without restrictions or limitations for any purpose. I understand and agree that these materials may be kept on file by City of Salem and used in the future.
    4. I understand and agree that the City of Salem may distribute the materials to third parties and third-party social media platforms such as Facebook, YouTube, Twitter, etc. I understand and agree that third-parties may use the materials in accordance with the third party’s policies, terms, and conditions. I understand and agree that my electronic mail address or other contact information may be shared by the City of Salem with third-parties for the purpose of contacting me regarding the materials.
    5. I understand and agree that the City of Salem is not my agent or representative. I understand and agree that I will not be compensated in any manner by the City of Salem with respect to the recordings, and my name, likeness, voice, and biographical material.
  5. To the extent permitted by law, and in consideration for being allowed to participate in the ACTIVITIES:
    1. I now save, hold harmless, defend, discharge and release the City of Salem and its officers, employees, agents, and volunteers, from any and all liability, claims, causes of actions, damages or demands of any kind and nature whatsoever that may arise from or in connection with my participation in the ACTIVITIES. This includes, but is not limited to, those claims arising from the negligence or carelessness of the City of Salem, its officers, employees, agents, and volunteers.
    2. I will indemnify, defend and hold harmless the City of Salem, its officers, employees, agents and volunteers, from any and all claims made by others that may arise from or in connection with my participation in the ACTIVITIES.
  6. I further understand and agree that this is a release of liability and indemnity agreement, and it is intended to be as broad and inclusive as permitted by law. If any portion of the document is held to be invalid, it is agreed that the balance of the document will continue in full force and legal effect. 
By signing below, I acknowledge:
  1. I have read the entire Acknowledgment of Risk and Waiver of Liability document agreement, I understand the document, agree to be bound by its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability of my own free act; and
  2. I agree this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties and its terms are contractual.
  3. I agree to the terms and conditions of my participation in the ACTIVITIES, and I hereby give my consent to receive all medical treatment determined to be necessary.

Electronic Signature Disclaimer:
I agree that by signing my legal name below, I am signing this waiver electronically. I agree that my electronic signature is the legal equivalent of manual signature on this form.  *This question is required.
Clear
Legal name of signer
0%