Upon completion of this registration, an email will be sent to you with the ZOOM link and other important information. If you are having technical trouble submitting the application or if you have any other questions, contact Zack Kilmer, Public Policy & AMPLIFY-NY Coordinator, at (518)-708-3808 or email@example.com
I hereby consent to and authorize the use of information for publication purposes to:
I consent to and authorize the use, publication, and reproduction of any and all photographs, digital images, videotapes or recordings made of me, and the right to copyright and/or use, reuse, modify, and/or publish, republish photographic pictures, digital images, videotapes or recording in conjunction with my name.
I also give permission for the photographs, digital images, videotapes, or recordings to be used in their entirety and/or edited versions, as deemed necessary, including the use of images on agency-operated websites.
Furthermore, permission is also given for the photographs, digital images, videotapes, or recordings to be used at any time in the future without further clearance from me.
I will help to create a youth peer community based on mutual respect and a sense of personal wellbeing. I will treat others with honor and respect because that is how I wish to be treated. I have read the following rules and guidelines, designed to promote a positive learning environment and the health and safety of all people attending the event. I have indicated my complete acceptance by my signing this form. If I am not a legal independent adult, my parent/guardian has signed the code of conduct form as well.
If you are bringing a support assistant to the VYLF, they must read and sign this seperate code of conduct