Sample Program Waiver

Youth Business Education Program Participation Waiver Form

Participant Information:
Name: ________________________________________
Date of Birth: _____________ Age: ______
Parent/Guardian Name: ________________________________________
Phone Number: ____________________ Email: __________________________

Program Description:
The Youth Business Education Program is a weekly learning opportunity that includes team-based projects, mentorship, and basic financial and business education. Activities may include interactive workshops, presentations, and supervised group work.

Acknowledgment and Assumption of Risk:
I understand that participation in this program is voluntary. While all reasonable safety measures will be followed, I acknowledge that participation in any group activity carries a potential risk of minor physical or emotional harm. I assume full responsibility for any risk or injury that may result from my child’s participation.

Medical Authorization:
In the event of an emergency, I authorize program staff to seek medical treatment for my child and release them from any liability for medical decisions made in good faith.

Liability Release:
I hereby release and hold harmless Synergy CPA Tax & Financial Services, program staff, volunteers, and partners from any and all liability, claims, or demands for any personal injury, illness, loss, or property damage that may occur during or as a result of participation in the Youth Business Education Program.

Media Release (Optional):
I give permission for photographs and videos of my child to be used for promotional and educational purposes.
☐ Yes ☐ No

Parent/Guardian Consent:
I have read and understood the above waiver. By signing below, I give my consent for my child to participate in the Youth Business Education Program.

Signature of Parent/Guardian: ___________________________ Date: ___________
Printed Name: _________________________________________

Signature of Participant (if over age 13): ___________________________ Date: ___________