YOUTH & GOVERNMENT. YMCA OF THE EAST BAY Brentwood Delegation MODEL LEGISLATURE & COURT Program Guide & Registration Forms

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1 YOUTH & GOVERNMENT YMCA OF THE EAST BAY Brentwood Delegation MODEL LEGISLATURE & COURT Program Guide & Registration Forms

2 WELCOME TO YOUTH & GOVERNMENT IMPORTANT DATES August th 1st meeting (Parent and participants) September th Registration & Financial Assistance deadline October st Payment #1 due November st Payment #2 due 5 th Bill Hearing Night 10 th to 12 th Training & Elections Conference I Fresno, CA December st Payment #3 due January st Final payment due 19th to 21st Training & Elections Conference II Fresno, CA February th to 18 th 71 st Model Legislature & Court Sacramento, CA March th New officer election, last meeting IN THE BEGINNING The YMCA Youth & Government program was established in 1936 in New York by Clement Pete Duran, then the Boys Work Secretary for the Albany YMCA. The program s motto, Democracy must be learned by each generation, was taken from a quote by Dr. Earle T. Hawkins, the founder of the Maryland Youth & Governemnt program. Encouraged by then Governor Earl Warren, Youth & Government made it s debute in California in TODAY Charted as an independent YMCA in 2001, The California YMCA Youth & Government is the premier organization that delivers a high-powered civic engagement experience serving close to 5,000 middle and high school teens annually. Middle School delegates enjoy a great experience on an international level solving world issues in Model United Nations. Where as high school delegtes partake in a model California creating and debating legislation and proposals and arguing court cases. TABLE OF CONTENT Important Dates...2 History of Y&G... 2 Adult Involement...3 CONTACT INFORMATION Richard Chapin Youth & Government Coordinator rchapin@ymcacba.org Missy Beaver Lead Volunteer Advisor beaverm@luhsd.net Ryan Raimondi Delegation President ryan.raimondi@icloud.com School Absence...3 Delegation Meeting Info...4 Conferences...5 Code of Conduct...6 Registration Info...8 Registration Foms MODEL LEGISLATURE & COURT BRENTWOOD DELEGATION

3 WELCOME TO YOUTH & GOVERNMENT Adult Involvement YOUTH & GOVERNMENT CORE STAFF The President/CEO of the California YMCA Youth & Government is employed by a Doard of Directors to administer the policies and the practices of the programs. Along with a small core staff, Y&G provides administrative services to local delegations, fundraise for financial assistance, and plan conference logistics. PROGRAM STAFF Each year over 200 volunteer program staff from across the state serve as program staff. Recruited and trainined by Youth & Government, these volunteers plan and execute each of the various program areas, perform logisitc duties, and provide and promote safety and wellness to all participants. They include everyone from teachers to lawyers to public service workers. DELEGATION ADVISORS Advisors provide the leadership to their own local delegations in preparing them for their paraticipation in the program. They accompany their delegation to all conferences and various events, provide direct supervision, and seeve as parlimentarians. Each advisors is trained in youth development and child abuse prevention. We maintain a ratio of 1 advisor to 10 delegatges. SCHOOL ABSENCE- SB 278 Lowenthal During the Model Legislature & Court conference in Sacramento, delegates will experience school absence. Mainly Thursday and Friday of that conference. In 2008, then Governor Arnold Schwarzenegger signed SB 278 (Lowenthal) into law allowing Youth & Government programs to be an excused absence from school. The full text of the section is below and may be found at by searching the education code for section (a) (7) (a) Notwithstanding Section 48200, a pupil shall be excused from school when the absence is: (7) For justifiable personal; reasons, including, but limited to, an appreaence in court, attendance at a funeral service, obervance of a holiday or ceremony of his or her religion, attendance a religious retreats, attendance at an employment conference, or attendance at an educational conference on the legislative or judicial process offered by a nonprofit organization when the pupil s absence is requested in writing by the parent or gardian and approved by the principal or a designated representative pursuant to uniform standards established by the governing board. The YMCA does their best to inform every school our delegates attend to receive full cooperation and support of this program. YMCA OF THE EAST BAY 3

4 BRENTWOOD DELEGATION MEETINGS OUR WEEKLY MEETINGS The delegation is ran by a delegate-lead team of officers that meet weekly to plan the evening s agendas. Here is a sample of what an agenda looks like: MEETING LOCATION Liberty High School nd St Brentwood, CA MEETING TIME 7:30pm to 8:30 pm MEETING DATES August 13, 20, 27, 2018 September 10, 17, 24, 2018 October 15, 22, 29, Invocation- Words of wisdom given by the Chaplain to set the positve tone for the meeting. 2. Family Groups- Delegates are placed into smaller groups where they develop close relationships, create legislation, discuss needs, get information, and ask questions about the program. 3. Officer/Advisor Time- This is the time when officers and or advisors deliver important information and remind delegates of due dates, deadlines, and other information. 4. Benediction- Our Chaplain ends the meetings with further deep thoughts leaving delegates with something to think about after the meeting. ANNUAL FUNDRAISING CAMPAIGN Our Annual Campaign takes please in the fall where we raise money for financial assistance and program stability. The Brentwood delegation has set a goal of $1,000 to help those who can not afford the full cost of this program. To donate, please contact Richard Chapin at rchapin@ ymcacba.org November 5, 26, 2018 December 3, 10, 17, 2018 January 7, 14, 28, 2019 February 4, 25, 2019 March 4, MODEL LEGISLATURE & COURT BRENTWOOD DELEGATION

5 STATEWIDE CONFERENCES TRAINING & ELECTIONS CONFERENCES The Training & Elections conferences are designed to give delegates the skills and knowledge to prepare themselves for their final conference in Sacramento. They learn soft skills, get information and training on the program areas and elect leadership roles. The weekends also provide fun social activities for delegate interactions. Detailed information will be provided two (2) weeks prior to each conference. MODEL LEGISLATURE & COURT CONFERENCE The Model Legislature & Court conference is the final event of the program. Through the five (5) days, delegatges will emulate various roles of our state government and court systems to set up a model California. The weekends also provide fun social activities for delegate interactions. Detailed information will be provided two (2) weeks prior to the conference. Training & Elections Conference I (T&E I) November 9-11, 2018 Fresno Convention Center Training & Elections Conference II (T&E II) January 19-21, 2019 Fresno Convention Center 71st Model Legislature & Court February 14-18, 2019 State Capitol, Sacramento Convention Center, and surrounding State buildings HOUSING Delegations will be housed in hotels in the convention center areas. Delegates are assigned four (4) to a room to minimize cost. The rooms will either have one kingsize bed or two queen-size beds. We do our best to assign these rooms equally among the genders. Roll away beds are not always avaiable so we ask those who may have an air mattress or sleeping pad to bring them along for comfort of those in single bed rooms. The amount of single vs. double rooms are not known until we arrive at each conference. We do our best to accommodate all special requests. TRANSPORTATION Transportation to and from all conferences are by chartered bus. Bus pick up and drop off locations and times vary between conferences. Information will be made available two (2) weeks prior to each conference of the delegation web page. SAFETY AND WELLNESS For our safety and wellness, Youth & Government provides trained volunteers known was Safety & Well ness Advisors (SWA). These individuals provide us services such as security and medical attention. They creaste program boundaries, provide additional supervision, and handle minor medical needs. During the evenings, the SWA enlists the help of the delegation advisors to perform duties to monitor delegate activity. This includes but not limited to floor duties at hotels, cross walk monitors, elevator monitors, culinary assistance, etc. SWA are housed at every hotel where there are Youth & Government delegations. The more we look out for each other, the safer everyone will be. YMCA OF THE EAST BAY 5

6 Y&G CODE OF CONDUCT It is essential to California YMCA Youth & Government (Y&G) that each participant enjoys the right to a safe environment. Being responsible for one s behavior at all times is a necessary part of self-government. It is critical that all participants, advisors, program volunteers, core staff and guests act responsibly. The Code of Conduct binds both youth and adults attending Y&G sponsored or coordinated conferences and trainings. There are no double standards. By choosing to participate in Y&G s programs, each participant (and their parent or guardian, should it apply) agrees that they have read, understand and will follow the Y&G Code of Conduct while attending Y&G activities. Local delegations may also have additional conduct standards. Each participant is accountable for preserving the reputation and high expectations of their delegation as well as that of California YMCA Youth & Government. All participants share equally in the responsibility to uphold and enforce the Y&G Code of Conduct and notify appropriate staff or an advisor of violations. Participants who do not remove themselves from situations or groups which constitute violations of this code will be considered a party to the violation. The regulations outlined below begin when the first youth participant arrives at the conference or training facility and are lifted only when the last youth participant has departed. I. GENERAL RULES Violations of General Rules a-i shall result in expulsion from all California YMCA Youth & Government (Y&G) conferences and trainings for the remainder of the program year. To ensure the safety of all participants, Y&G reserves the right, if deemed necessary, to conduct searches of baggage, rooms and persons; including the use of Breathalyzers. Y&G may refer incidents involving illegal conduct to local law enforcement agencies for criminal prosecution. a. All program participants shall give the highest care and attention to the public and private facilities placed at the disposal of California YMCA Youth & Government. Specific rules set by individual facilities (i.e. YMCA, State Capitol, Convention Centers, Hotels, Camps, etc.) must be observed. Any act of vandalism, destruction of property, misuse of a facility and or harassment of a facility staff member is strictly prohibited. b. Possession and or consumption of illegal drugs is strictly prohibited. c. Possession and or consumption of alcoholic beverages, tobacco, nicotine, e-cigarettes, or vape pens in any form (with or without nicotine, etc.) is strictly prohibited. Regardless of a medical doctor s prescription, possession or consumption of marijuana is prohibited. d. Weapons of any kind, including items that might cause injury to others or damage to property are strictly prohibited. e. Conduct that endangers the health and safety of oneself or others is prohibited. f. Physical, psychological, verbal, nonverbal, written or cyber abuse including harassment of any kind is strictly prohibited. g. Acts of dishonesty, fraud, or falsification of records is strictly prohibited. h. Inappropriate or uninvited physical contact between Y&G participants, staff, advisors, program volunteers or guests is strictly prohibited. i. Intimate sexual behavior is strictly prohibited. Violations of General Rules k-q may result in expulsion from California YMCA Youth & Government (Y&G) functions and conferences: j. A Y&G provided name badge shall be worn at all times by every participant, staff member, advisor and program volunteer when they are not in their sleeping rooms. Badges are to be worn above the waist and must be visible. Badges are not to be defaced, decorated, or altered in any way. Badge switching and or sharing is prohibited. Only advisors may request replacement badges for participants. k. Participants shall be present and punctual to all meetings where their involvement is expected or required. l. Participants shall observe all curfews and be in their assigned sleeping rooms at the established curfew times. Participants may not switch rooms without advance permission from their delegations lead advisor. m. Participants shall observe the following rules regarding hotel rooms for conferences. Model Legislature & Court: At Training and Election conferences, no delegate shall be present in any hotel room or sleeping quarters assigned to members of the opposite sex unless an advisor is present in the room. At MLC Sacramento, no delegate shall be present in the hotel room with a member of the opposite sex unless an advisor is present in the room; or there are five or more participants present in the room, two of which are the same sex ( ratio rule ). Model United Nations: Ambassadors are not allowed in sleeping rooms other than their own. Page 1 of 2

7 n. Y&G does not permit participants to drive vehicles to or from any of its related conferences. Advisors seeking to drive during a conference shall obtain clearance through Y&G. In all cases, liability is assumed by the sponsoring local YMCA or school. o. All electronic devices must be silenced and not visible during all sessions, meetings and hearings in all program areas unless they have been specifically authorized for use by Y&G staff or volunteers. Advisors should leave the room if they need to use their device in a manner that disrupts the session, meeting, or hearing. p. While at conferences, participants may not have in-person contact with anyone not participating in or associated with Y&G without prior clearance from the program or their delegation and lead advisor. This includes family and friends that may wish to visit in-person. II. DRESS CODE & CONFERENCE SPECIFIC RULES For each program, refer to the Dress Code and Conference Specific Rules printed in the program handbook for additional participation requirements. California YMCA Youth & Government s CEO has the authority to determine both the appropriateness of appearance and attire of participants, advisors and program volunteers. III. DISCIPLINARY ACTIONS a. The Code of Conduct is binding for all participants, advisors, program volunteers and staff. Each person will be accountable for his/her actions. In addition, each YMCA or school and shall be held accountable for the conduct of their participants and advisors. b. California YMCA Youth & Government s CEO has the authority to make accommodations under or exceptions to the Code of Conduct. Any delegation seeking an exception or accommodation must clear it in advance with their local YMCA Executive Director/CEO or, in school-based delegations, School Principal and must provide a written request to the Y&G CEO prior to the related conference. c. California YMCA Youth & Government s CEO or their designee has the authority to interpret the Code of Conduct and administer any disciplinary action deemed necessary. d. All expenses and arrangements related to any disciplinary action or expulsion from the program are the sole responsibility of the parent or guardian of the delegate. If a parent is unable to assume financial responsibility for the delegate, then the YMCA or school shall assume responsibility. IV. LOCAL DELEGATION RULES Each YMCA or school may outline additional or stricter rules of conduct for its delegation as long as they do not conflict with or attempt to diminish any standard in the Youth & Government Code of Conduct. A violation of either the Y&G Code of Conduct or the local delegation s rules may subject the offender to dismissal from the program. Delegation advisors shall be responsible for enforcing such additional rules of their local YMCA or school. Updated July 20th, 2018 Page 2 of 2

8 REGISTRATION INFORMATION PROGRAM FEE The program fee for is $1,400. It covers a variety of expenses such as: Conference registration fees Conference transportation and lodging Delegation appearal Delegation dinner in Sacramento Program expenditures* *Direct expenses to cover volunteer Advisor s registration fees, transportation, lodging, and indriect administration expenses. PAYMENT INFORMATION & SCHEDULE Program fees can be paid for by using the following: Bank Draft/EFT Credit Card (American Express, MasterCard, or VISA) Personal checks or money orders will NOT be accepted unless it is for the full fee. No exceptions. Make checks payable to YMCA of the East Bay Payments can be made for the full amount or by the payment schedule below. If a payment is missed, it will be added to the next due date. If a participant misses two (2) payments in a row, they will be considered to be terminated from the program with no refunds, It is the responsibllity of the parent/guardian to make sure payment is received on time. Payment Amount Draft/Due Date 1 $350 October 1, 2018 REFUND POLICY Refunds must be requested, in writing, seven (7) days prior to a payment/draft in order for all future payments to be refunded. However once a payment/ draft date has passed, the fee is no longer refundable. Our expenses for the program depend on the payments from our delegates. Same process applys for those who pay for the program in full. RETURN PAYMENTS Payments not honored by the bank for any reason will incur a $15 return payment fee. For those on credit card draft, please make sure the expiration date on the card has am expiration after 02/2019. It will be the responsibility of the cardholder to inform Richard Chapin of any changes in the card information. FINANCIAL ASSISTANCE Here at the YMCA we do not turn away those from programs who are unable to afford the full fee. Our finanical assistance (FA) program is available on a first come, first serve basis. To qualify, applicants must attend all required program conferences. Failure to do so will result in loss of assistance. Please make sure that all reqired information is filled out with backing documents stated on the application before you turn it in. Imcomplete applications will not be processed. All are welcomed and encouraged to apply. Funds for our FA program are raised by the delegates, their family, and friends during our Annual Fundraising Campaign. Last day to apply is September 10, $350 November 1, $350 December 1, $350 January 1, 2019 When paying by bank draft or credit card, we will set up an automatic payment based on the draft date above. 8 MODEL LEGISLATURE & COURT BRENTWOOD DELEGATION

9 REGISTRATION INFORMATION Please follow these steps for a successful registration in to the Youth & Government program Step #1 Please read through this guide and note important information on dates, deadlines, responsibilities and other desescriptions. Step #2 Complete all registration forms at the end of this guide. 1. The primary adult in the household should to complete the forms. 2. All forms are formated as a writable PDF for your convience. 3. If you choose to handwrite, please use black or blue ink. 4. Print and sign all signature areas. 5. Return forms on the due date designated by the Lead Advisor or mail to Richard at the YMCA-PG&E Teen Center. Address is on the back cover All parts of forms and waivers need to be filled out and agreed upon in order to participate in this program. Step #3 Once your paperwork has been entered in our registration system, the primary adult will receive an with instructions on how to set up their My Y Account. My Y Account allows the primary adult to: Enter bank draft and credit card information Update any change of address, phone, or Pay any outstanding or future balances. The YMCA can no longer take full credit card/bank draft information on paper for the protection of your information. Step #4 The last step is conference registration through California YMCA Youth & Government. Once the conference event is open in their registration system, all participants will receive information on how to register. Failure to do so after the closing deadline will result in removal of the program. For registration or My Y Account assistance, contact Richard Chapin at or rchapin@ymcacba.org YMCA OF THE EAST BAY 9

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11 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation FOR YMCA ADMINISTRATION ONLY: Date Received: Date Entered in DAXKO: Entered by: Member ID: Participant Name (1 person per packet) First: Last: Gender: Male Female Other Address: City: Zip: Primary Phone: Secondary Phone: Birth date (mm/dd/yyyy): Age: School: Grade: African American Asian/Pacific Islander Caucasian Hispanic/Latin Middle Eastern Multi-Racial Native American Other Years in the Model Legislature & Court program: Sweatshirt Size(Adult unisex size): Parent/Guardian (Primary)Main adult contact person living with this delegate First: Last: Birth date (mm/dd/yyyy): Primary Phone: Secondary Phone: Parent/Guardian (Secondary) Alternative adult contact person for this delegate First: Last: Birth date (mm/dd/yyyy): Primary Phone: Secondary Phone: Family Information Main Language Spoken at Home: Main Language Spoken by Parents: Family Income: Under $20,000 $50,001 to $60,000 $20,000 to $30,000 $60,001 to $70,000 $30,001 to $40,000 $70,001 to $80,000 Family information collected here is used by the YMCA strictly for data collection to be used for reporting and funding purposes only. $40,001 to $50,000 Over $80,000 Total Number of People in Household: Does the participant qualify for free/reduced lunch? Yes No

12 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation YMCA of the East Bay RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: 1. THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused bv the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. Signature of Agreement I have read and understand this document and release Participant Name (Print): Participant Signature: Date: Printed Name of Parent/Guardian: Parent/Guardian Signature: Date:

13 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation Participant Medical Information for YMCA of the East Bay First: Last: Gender: Male Female Other Address: City: Zip: Primary Phone: Secondary Phone: Birth date (mm/dd/yyyy): Age: Parent/Guardian (Primary) First: Last: Primary Phone: Secondary Phone: Parent/Guardian (Secondary) First: Last: Primary Phone: Secondary Phone: Emergency Contact Name: Primary Phone: Secondary Phone: Name: Primary Phone: Secondary Phone: Medical Insurance Carrier: Dental Insurance Carrier: Policy Number: Policy Number: Medical History (check all that apply) ADD/ADHD Asthma Bleeding/Clotting Disorder Celiac Disease Chicken Pox Currently under Dr. Care Diabetes Ear Infection German Measles Heart Defect/Disease Measles Migraines Seizures Sleepwalking Tuberculosis List Other Medical History Here:

14 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation Allergies (check all that apply) Foods Bee Stings Hay Fever Pollen Penicillin Other Insects Stings Other Drugs Other Allergies List Specific Food and/or Other Allergies Here: List Dietary Restrictions Here: What (if any) medical condition(s) do you have that could affect your experience in this program? If you are taking any prescription medication, please list them. List any past serious medical treatment such as operation, injuries or restrictions. Is your teen currently involved in therapy? Yes No Please explain: Does your teen require special accommodations? Yes No Please explain: If you are taking any prescription medication, please list them.

15 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation Please read the following. Every section must be agreed upon in order to participate in this program. Medical Release I hereby authorize YMCA of the East Bay and its authorized director and/or leaders (collectively the YMCA) or an authorized representative of the Y&G program in conjunction with the local YMCA to act as guardians for the above named individual. The guardianship grants authority to consent to any medical, dental, surgical or mental health diagnosis or treatments, and hospital care to be rendered to the individual under general or special supervision and upon advice of a health care provider licensed under the laws of the state or any other jurisdiction in which emergency medical care is sought. For the purpose of medical care or dental care obtained in the State of California, this authorization is given pursuant to the provisions of section 25.8 of the California Family Code, as amended. I have read and agree to these conditions. For parents or guardians with participants under 18, all efforts will be made to contact the minor s parent or legal guardian prior to the rendering of medical or dental care. If the emergent nature of the event demands immediate attention, the above listed guardians are authorized to provide the necessary permission needed for required treatment required. The undersigned understands and agrees that YMCA of the East Bay and California YMCA Youth & Government shall not legally or financially liable for any claim arising from the medical, dental, or mental health care provided pursuant to this authorization. I hereby indicate by the signature below that I am the authorized parent or legal guardian for the above minor. The undersigned hereby agrees to indemnify and hold YMCA of the East Bay harmless from any claim made by or on behalf of said individual arising out of any medical, dental, or mental health care provided pursuant to this authorization. This authorization is given to YMCA of the East Bay for use in conjunction with any event operated by YMCA of the East Bay including transportation to/from the event and shall be valid until revoked in writing by the undersigned. Code of Conduct Agreeance For participants: By signing, I acknowledge that I have read, understand and will follow the California YMCA Youth & Government (Y&G) Code of Conduct at all conferences or YMCA functions. For parents/guardians of participants: By signing, I acknowledge that I have read and reviewed the Code of Conduct with my child and I accept the responsibility for my child s adherence to it. I also understand that if my child violates the Code of Conduct and is expelled from the program, that I am responsible for their immediate transport home from the conference or YMCA function. This transport shall be done at my expense. Anonymous Data Collection Release YMCA of the East Bay (YEB) continually strives to improve the program experience for participants. As part of that process, we work with other YMCA organizations as well as outside researchers to design and implement surveys to learn about experiences and growth during Y&G, as well as standard background information. The information collected is held in confidence by YEB and the researchers have no ability to identify any individual participant. Identifying information will never be released to anyone outside YEB. During the course of our study, we hope to conduct interviews with individual participants. Before that is done, the participant and their parent or guardian will be asked to sign an additional consent form. I have read and agree to these conditions. Media Release Permission is granted for photographs, DVD, video or audio recording of participants that are taken during their participation in the YMCA of the East Bay (YEB) and California YMCA Youth & Government (Y&G) program, in any format including electronic media, to be used by the program for any purpose, including publicity. The participant and his/her parents hereby waive and forever relinquish any rights to such images, waive the right to prior notice of such use, and acknowledge the right for YEB and Y&G to use such images without compensation. I have read and agree to these conditions. Participant Hotel Accommodations I understand that hotel sleeping accommodations are shared with other participants up to the maximum allowed by fire code as determined by hotel standards. Delegates seeking reasonable housing accommodations must communicate their request in advance of conferences to their local YMCA who will work with Y&G housing team. If there are any concerns or questions about housing at conferences, contact the YMCA of the East Bay. Program Guide Acknowledgement I, as the parent/guardian, hereby understand and acknowledge that I have read or in the process of reading the program guide for the Youth & Government s Model Legislature & Court program. By signing this form, I acknowledge that I understand the provisions, and agree to abide by the rules, polices, and standards set forth in the guide. If I need further clarification, I will contact the YMCA. Signature of Agreement I have read, understand, and agree to the statements above Participant Name (Print): Participant Signature: Date: Printed Name of Parent/Guardian: Parent/Guardian Signature: Date:

16 YMCA of the East Bay Youth & Government, Model Legislature & Court Brentwood Delegation Payment Form Participant s First and Last Name: Primary Form of Payment (Personal checks or money orders are NOT accepted unless it s for the full fee) Credit Card OR Bank Draft/EFT Name on Account: Last 4 digits on card: Expiration Date: Name on Account: Last 4 digits of Routing Number: Last 4 digits of Account Number: Secondary Form of Payment (Personal checks or money orders are NOT accepted unless it s for the full fee) This account will be used when the Primary Form of payment is returned. It will be drafted automatically with a $25 fee. Credit Card OR Bank Draft/EFT Name on Account: Last 4 digits on card: Expiration Date: Name on Account: Last 4 digits of Routing Number: Last 4 digits of Account Number: Payment Frequency Fee in Full- $1,400 Payment Schedule (See page 8 of the Program Guide) Financial Assistance (Optional) I want to apply for assistance No, thank you Assistance is on a first come-first serve basis. In order to process, the signed application and backing financial are required. Application at Incomplete applications will not be processed. Annual Campaign Fundraiser (Optional) I would like to make a tax-free contribution to the Annual Campaign to help those participants who could otherwise not afford to participate. Make check payable to YMCA of the East Bay Ck# Agreement- Please initial Payments not honored by the bank for any reason, (including returned check, NSF, closed account, invalid expiration date, referral) will incur $15 returned payment fee. This is in addition to any fees charged by the bank. In the event a payment is returned, we will automatically redraft, using the second form of payment and will include the $15 return payment fee. The YMCA has the right to initiate legal action for collection of fees or outstanding balances, and the undersigned will be responsible for all costs of collection, including court expenses and reasonable attorney s fees. I HAVE CAREFULLY READ THE ABOVE AGREEMENT AND AGREE TO ABIDE BY ALL OF ITS TERMS. Signature: Date:

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18 YOUTH & GOVERNMENT MODEL LEGISLATURE & COURT Brentwood Delegation YMCA OF THE EAST BAY YMCA-PG&E Teen Center 2111 Martin Luther King Jr. Way Berkeley, CA