Disability Pride Forum 2025 Consent Form

The following form is required for youth ages 14-24 to participate in this official one∙n∙ten activity.

When this form is complete and submitted, a confirmation email will be sent to the email(s) provided.
Program Name: Disability Pride Forum
Activity Description: day long program on Saturday, April 26 10am - 4pm
Location: one•n•ten Downtown Youth Center (1101 N. Central Ave, Suite 104, Phx, AZ 85004)
Food: Lunch provided along with snacks & drinks.
Youth Info






Details on meet up spot, time & length of
program will be sent to this email.

Guardian Information




Medical Information






one∙n∙ten is unable to guarantee allergy free environments in public spaces

Emergency Contact






In consideration of being allowed to participate in one∙n∙ten activities, I hereby release the sponsoring organizations, their boards, officers, employees, and volunteers (herein known as one∙n∙ten Staff) from any and all liability, claims, demands, or course of action whatsoever arising out of or relating to any loss, damage, or injury, including death, that may be sustained by me/my child, or to any property belonging to me, whether caused by the negligence of the one∙n∙ten Staff or otherwise, while participating in this program, or while in, on, or upon the premises where the program is being conducted.

To the best of my knowledge, I/my child, is in good physical and mental condition and I am not aware of any physical or mental infirmity which would place me at risk to participate in any way in program activities, including those that are outdoors. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in the program activities, whether caused by the negligence of the one∙n∙ten Staff or otherwise. I further hereby agree to indemnify and hold harmless the one∙n∙ten Staff from any loss, liability, damage or cost, including court costs and attorney’s fees, that may accrue related to my participation in this program, whether caused by the negligence of the one∙n∙ten Staff or otherwise.

During the period of the program, I hereby give permission for the one∙n∙ten Staff to administer appropriate first aid (including over-the-counter medicines) and to authorize any medical attention or emergency treatment deemed necessary for me/my child in the event of an accident, illness, or injury. I will be responsible for any and all costs of medical coverage and treatment provided not covered by personal insurance.

It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the member of my family and spouse/partner, if I am alive, and my heirs, assigns, and personal representative, if I am deceased, and shall be deemed as a release, waiver, discharge and covenant not to sue the one∙n∙ten Staff.

I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Arizona. In signing this release, I acknowledge and represent that I have carefully read this document and fully understand the contents, meaning, and impact of the agreement; I sign this document freely and voluntarily without any inducement; I am at least 18 years of age and fully competent; and I execute this release for full, adequate, and complete consideration, fully intending to be bound by the same
Consent