Participant Release Form

Participation Agreements

LIABILITY AGREEMENT

I hereby release, indemnify and hold harmless GenPride, its officers, directors and employees, and the organizers, sponsors and supervisors.

Additionally I hold them harmless from any and all liability in connection with any injury I may sustain (including any injury caused by negligence) in conjunction with participating in GenPride activities.

I am acknowledging that I have read and understood the GenPRIDE Liability Agreement:

Yes, I understand.No, I am not comfortable or do not understand.

CODE OF CONDUCT

GenPride empowers older LGBTQIA+ adults to live with pride and dignity. Participation in the organization’s programs is subject to the observance of the organization’s rules and procedures.

In order to create a safe and welcoming environment for all, the following activities are strictly prohibited. Any participant, volunteer, presenter, or staff member who violates this Code is subject to discipline, up to and including removal from the program.

• Abusive language towards a staff member, volunteer or another participant.

• Possession or use of alcoholic beverages or illegal drugs on GenPride’s property or reporting to the program while under the influence of drugs or alcohol.

• Bringing onto GenPride’s property dangerous or unauthorized materials such as explosives, firearms, weapons or other similar items.

• Discourtesy or rudeness to a fellow participant, staff member or volunteer.

• Verbal, physical or visual harassment of another participant, staff member or volunteer.

• Actual or threatened violence toward any individual or group.

• Conduct endangering the life, safety, health or well-being of others.

• Failure to follow any agency policy or procedure.

• Bullying or taking unfair advantage of any participant.

• Failing to cooperate with a supervisor/leader/mentor.

I have read and I understand GenPride’s Code of Conduct. I agree to abide by the rules described above and understand that I may be removed as a participant if I violate any of these rules.

Yes, I understand.No, I am not comfortable or do not understand.

PHOTO / VIDEO CONSENT

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to GenPride, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:

(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;

(b) Permission to use my name; and

(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

I am acknowledging that I have read and understood that by agreeing to this field GenPRIDE may take photos or videos at events and not have to ask me for permission.

Yes, I understand.No, I am not comfortable or do not understand.

ACKNOWLEDGEMENT

Please enter your full name and email into the box below to acknowledge the read receipt of the above agreements. By signing below you are providing consent and agreement to the listed sections of the participant agreements within this form.

All information completed within this application remains confidential to GenPride.

Your First Name

Your Last Name

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Contact Information
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Participant Release Form

Participation Agreements

1521 Broadway, Suite A, Seattle, WA 98122
Phone: 206-393-3400 - info@genprideseattle.org

PO BOX 23123, Seattle WA 98102 [EIN: 47-5593899]