General Release & Registration for After School Sweet Readers Sweet Readers, Inc. ("The Charity") is a 501(c)3 tax exempt public charity, founded in 2011 and based in Manhattan. Our mission is to empower young people through training, transformative programs and communities of support to revitalize adults living with Alzheimer's and related disorders (AD) and become catalysts for excellence in eldercare. During our programs, young people are challenged to utilize science, human engagement and the arts to discover the person behind the disease and meaningfully connect. We call all of our trained middle school aged participants Sweet Readers and are delighted your child (my "Child") will soon join other middle schoolers around the world as a Sweet Reader! The Sweet Readers After School Programs, including multigenerational, training and community engagement sessions (the "Program"), will be held in partnership with Sweet Readers and an eldercare center and/or museum (the "Partners") at either the eldercare center or the museum with orientation, some community events and science training being held at a common venue bringing together students from multiple school communities. Program sessions will be led by a trained facilitator utilizing one of the Charity's customized curriculua. GENERAL RELEASE I acknowledge and agree: In the interest of consistency and meaningful connections, I promise to make best efforts to ensure my Child attends every session in the Program(s) for which he/she/they are signed up. If my Child is unable to attend any session, I will notify the Charity as soon as practicably possible by email: programs@sweetreaders.org or phone: 917.828.2970. My Child is to the best of my knowledge, in good health to undertake the normal range of activities contemplated by the Program and will not attend the program if feverish, ill or with any communicable diseases or viruses. I also acknowledge that as a condition of participating in the Program, my Child possesses comprehensive medical/health insurance which will be in effect throughout my Child's participation in the Program; and As a Sweet Reader, my Child remains fully subject to the Partner's rules and regulations concerning my Child's conduct, including the right of either of the Partners to suspend, limit or terminate my Child's participation in the Program for any reason either of the Partners deem proper. As part of my Child's participation in the Program, my Child may be asked to fill out evaluations to support the Charity's ongoing efforts to improve the quality of their programming. These evaluations may also become part of a larger study of the impact of the Programs on participants. My Child agrees to answer the questions to the best of his/her/their knowledge and the Charity agrees not to publish my Child's last name in connection with the Program without my prior written consent. Image, Voice & Works Release I hereby irrevocably consent to and authorize the Charity to use any photographs, audio and/or videos of my Child and/or any works (artworks, poetry, etc.) my Child may create during the course of the Program in order to promote and publicize the Charity, its mission and its programs, in any medium. The Charity agrees not to publish my Child's last name without my prior written permission. General Release & Registration for After School Sweet Readers I further acknowledge that the Charity is the owner of all rights in and to the aforementioned photographs, videos and/or works. By signing below I agree to allow my Child to participate in the Program and hereby release and will indemnify and hold harmless the Charity, its employees, officers, directors, agents and representatives, to the fullest extent permitted by applicable law, from all claims, demands and liability of any kind including without limita- tion, all personal injuries including loss of life and expenses including reasonable attorney's fees, arising my Child's participation in the Program and/or the display, distribution, reproduction or other use of the photos, videos, audio and/or works which may be produced during or for the Program, excluding claims arising directly from the willful misconduct or grossly negligent acts of the Chairty. The indemnity set forth in this paragraph shall survive termination of this Release. By signing below, I warrant that I have the right to enter into this Agreement, including, without limitation, on behalf of my Child, named below and I give permission for my child to be released from the program as indicated below. Child's Name* First Last Birth Year1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019Child’s School*Grade*Child’s Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Guardian’s Name* First Last Parent/Guardian’s Email* Enter Email Confirm Email I would like to serve as an event volunteer* Yes No I would like to serve as a program chaperone* Yes No I would like to learn about other Sweet Readers programs* Yes No Please indicate the best way to reach you:*EmailTextPhoneRegistrationTo register your child, please check the program(s) you wouild like to register for below:* After School at The Jewish Museum, Fall. Mondays 4:00pm-5:00pm, begins on October 28, 2019 After School at The Jewish Museum, Spring. Thursdays 4:00pm-5:00pm, begins April 23, 2020. Please indicate how your child will be released from the program sessions:* My child has my permission to walk home or take a taxi, bus or car service home without chaperone. My child will be picked up My child will be picked up by* First Last The person named here can be reached via text/cell at this number:*and by email:* Emergency Contact Name* First Last Emergency Contact Cell/Text:*Emergency Contact’s Relationship to Child:*ParentOther RelativeCare ProviderRegistration*The registration fee for the full year, regardless of how many programs you sign up for is $50. You may either register here (the online processing fee is $1.75 for a total registration fee of $51.75) or by mailing a check in the amount of $50, made payable to: Sweet Readers, Inc. to Sweet Readers at: Sweet Readers, 275 Central Park West, #4F, NY, NY 10024. Registration fees are non-refundable and Financial Aid is available on a needs basis. Programs fill on a first-come/first-served basis. Price: $51.75 Parent/Guardian’s Signature*Date* Date Format: MM slash DD slash YYYY READ MORE