Parent/Guardian's Signature
(Please sign in the space below the agreed terms)

I/we the undersigned, parent(s)/guardian(s) having legal custody/legal guardianship of said minor, give permission to attend any of the Middle School After-School Program activities.  The said minor is physically able and mentally prepared to participate in all activities as described for said program. I/we hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the activities for which I/we have given my/our permission and thereby will not hold the Wichita YMCA & Wichita Public Schools liable for any injuries incurred during these activities.

1. I/we do hereby grant permission for the said minor to be transported by a properly insured vehicle as required by (Kansas Law KSA 40-3107e) to and from the activities associated with the Middle School After-School Program.
2. I/we do hereby grant permission for photos of my/our child to be used by the Wichita YMCA & Wichita Public Schools for promotional and educational purposes.
3. I/we do hereby grant permission for student surveys to be given to my/our child pertaining the Wichita YMCA & Wichita Public Schools.

My signature below certifies that the information I have provided above is true and accurate under penalty of perjury.