REC Youth Leadership Retreat for Community Impact: Parental Consent Form Participant's First NameParticipant's Last NameAgeDate of BirthMonthDayYearStreet AddressCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhoneEmail AddressParent/Guardian's First NameParent/Guardian's Last NameEmergency Contact Information:First NameLast NameRelationship to Participant:Phone Number:Health Information:Please list any allergies or medical conditions that we should be aware of:Authorization for Emergency Medical TreatmentIn the event of a medical emergency, I authorize FEZANA to obtain the necessary medical treatment for my child.Photography and Social Media Consent:I grant permission for my child's photograph and/or video to be taken during the event for promotional and documentation purposes.Drop Off InstructionsI will drop off my child from Noon to 5 pm at the Sacramento Zoroastrian Association.I acknowledge and agree that FEZANA will arrange for airport pick-up on June 28, 2026.Pick Up InstructionsI will pick up my child from the Z Games Registration.I acknowledge and agree that FEZANA will arrange for airport drop-off on June 30, 2026.Consent for ParticipationI, {name-3-first-name} {name-3-last-name}, give my consent for my child, {name-1-first-name} {name-1-last-name}, to participate in the REC Youth Leadership Retreat for Community Impact from June 28th - June 30th, 2026. April 15, 2026I Consent for ParticipationWAIVER, ASSUMPTION OF RISK, INDEMNIFICATION, AND RELEASE OF LIABILITYThe undersigned shall be permitted by the FEDERATION OF ZOROASTRIAN ASSOCIATIONS OF NORTH AMERICA, a non-stock corporation organized under the laws of the State of Illinois, (collectively referred to as “Organizer”) to participate in the 2026 REC Youth Leadership Retreat for Community Impact (“Program” or “Activity”). In consideration of Organizer permitting the undersigned to participate in the Program, the undersigned (on behalf of the undersigned and on behalf of the undersigned’s heirs, assigns, personal representatives, family and next of kin) does hereby release, waive, hold harmless and forever discharge Organizer, its agents, affiliates, successors and assigns, any management company, and any and all related persons, firms, companies and corporations whether herein named or unnamed of any of them from all actions, causes of action, claims, demands, suits, damages, costs, expenses, compensation, third-party actions, suits at law or in equity, including claims or suits for contribution and/or indemnity of whatever nature, and all consequential damages (e.g., attorneys’ fees, penalties, etc.) on account of or in any way arising out of the Activity or participation in the Program (including without limitation all or any claims for negligence, gross negligence, wilful or wanton misconduct of Organizer, injury, death or disability or whether arising from or caused by the negligence, gross negligence, wilful or wanton misconduct of Organizer.) The undersigned understands the inherent risks, both to person and property, and danger associated with the Activity and is aware of all risks, direct or indirect, of participating in the Activity and acknowledges that the undersigned’s participation is voluntary and optional. The undersigned understands that the Activity may involve the risk of injury, death or loss to person and property and this document is intended to address ALL RISKS OF EVERY KIND associated with the Activity, including without limitation such risks that may be created by action, inaction and/or negligence of Organizer. The failure of Organizer to foresee or protect the undersigned from these risks or from the actions, inactions, recklessness or intentional or criminal misconduct of others or from inadequate supervision, if any, will not create any liability on the part of Organizer. This document may not be changed unless in writing. In the event that any clause or provision of this document is held to be invalid, the invalidity of such clause or provision shall not affect the remaining provisions and the remaining terms and conditions shall continue in full legal force and effect. This document shall be governed by the laws of the State of Maryland. THE UNDERSIGNED KNOWINGLY AND FREELY ASSUMES ALL RISKS RELATED TO ACTIVITY, BOTH THE RISKS KNOWN AND UNKNOWN, EVEN IF ARISING FROM NEGLIGENCE, GROSS NEGLIGENCE, AND/OR WILLFUL OR WANTON MISCONDUCT OF ORGANIZER AND THE UNDERSIGNED ASSUMES FULL RESPONSIBILITY. THE UNDERSIGNED, HEREBY RELEASE ORGANIZER ITS EMPLOYEES, AGENTS, VOLUNTEERS, OFFICERS, DIRECTORS, CONTRACTORS, SUB-CONTRACTORS, SUCCESSORS AND ASSIGNEES FROM ANY AND ALL LIABILITY, CLAIMS OR DEMANDS OF WHATEVER NATURE WHICH MAY ARISE FROM THE UNDERSIGNED’S PARTICIPATION IN THE ACTIVITY DURING THE APPROPRIATE TIME PERIOD. THE UNDERSIGNED AGREE TO INDEMNIFY AND HOLD THE ORGANIZER HARMLESS FOR ANY TORTS, ACTIONS, DEMANDS, DAMAGES OR CLAIMS OF ANY KIND OR NATURE, MADE BY ANY PERSON (SPECIFICALLY INCLUDING, BUT NOT LIMITED TO, THE UNDERSIGNED) THAT MAY ARISE OR RELATE TO THE ACTIVITY, EVEN IF SUCH CLAIMS INVOLVES A CLAIM THAT THE ORGANIZER’S ACTIONS WERE NEGLIGENT. THE UNDERSIGNED HAS CAREFULLY READ THE FOREGOING AND KNOWS THE CONTENTS THEREOF, AND SIGNS THE SAME AS THE UNDERSIGNED’S OWN FREE ACT. THE UNDERSIGNED FURTHER UNDERSTANDS THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING AND FULLY INTENDS THIS AGREEMENT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. THE UNDERSIGNED REPRESENTS AND WARRANTS THAT HE/SHE IS EITHER (1) AGE EIGHTEEN (18) OR OLDER; OR (2) IS THE LAWFUL PARENT AND/OR LEGAL GUARDIAN OF A PERSON UNDER THE AGE OF EIGHTEEN (18) WHO SHALL PARTICIPATE IN THE ACTIVITY, AND HAS FULL LEGAL CAPACITY TO ENTER INTO THIS DOCUMENT AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT OR DURESS.I ConsentAmount Due$USDCurrencyUSDSubmit