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Summer Service Learning 2025 Registration
Participant
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Does the participant have any allergies?
Does the participant need any special accommodations?
Emergency Contact (if parent/guardian can't be reached)
Emergency Contact's First Name
Emergency Contact's Last Name
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Relationship to participant
As part of this program, photos and videos will be taken for marketing and promotional purposes.
Publicity Release Waiver
I hereby give consent to JASA to use, edit, and publish images and videos of my participating child for purposes of publication, promotion, advertising, printing, emailing, copying or web publishing. JASA may also photograph, videotape, and share content from my personal social media accounts on posts related to JASA and older adults.
I waive any right to inspect or approve the finished product or to receive compensation arising or related to the use of the photo wherein my likeness appears.
I have read and understand the above PR rights release. I affirm that I am at least 18 years of age.
Yes
No
Download Service Week Waiver form
Please download this file:
Service Week Waiver
, and upload the completed and signed file below, or email it to development@jasa.org. A completed waiver is required for participation.
Upload Completed Service Week Waiver form
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