Online Enrollment Form

Participant Name:

Address:

Have you participated in YES programs in the past?

Parent/Guardian Name:

Please read and initial the following.  Both youth and guardian must initial.

I hereby give Youth Enrichment Services, Inc. permission, with respect to any photographs, videos, or images that it takes during program activities of me or in which I may be included with others: 1) To use, re-use, publish, and republish the same, in whole or images, individually or in conjunction with other photographs, in any medium for the purpose of promoting Youth  Enrichment Services, Inc. and, 2) To use my name in conjunction therewith if Youth Enrichment Services, Inc. so chooses.

To increase the quality of services that your child/family and other participants receive, Youth Enrichment Services, Inc. (YES) is involved in a number of ongoing improvement initiatives and research.  Your data may be used for professional research purposes.  Information that could identify any specific client will not be used in research and YES takes all steps possible to protect private participant information from unauthorized disclosure, tampering, or damage.  YES may have occasion to use case information as examples when writing or speaking about services or related topics in a public or educational setting. In most cases such examples are actually a compilation of the staffs’ experiences and not information about a specific case. In any event, information that could identify any client specifically is never used in this context.  By your initials below, you indicate that you have read and been informed of this policy and the organization’s ongoing research practices.

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