Teen & Young Adult GroupChildren’s Clinics offers a fun and free Teen & Young Adult Group for ages 13 years and up. We invite you to join us once a month as we enjoy light snacks, connect with others, and participate in fun and inclusive activities. Teen & Young Adult Group Registration Does the participant receive services at Children's Clinics?* Yes No If referred to our teen group by a Children's Clinics Employee, please put employees name below.Participant Name* First Last Age*Parent/Guardian Information* First Last Relationship to Participant*Primary Phone Number*Parent/ Guardian Preferred Email* Address* Street Address Address Line 2 City ZIP / Postal Code Emergency Phone*Emergency Contact First and Last Name*Please identify an individual other than yourself that we can contact in case of an emergency.Will the participant need 1:1 assistance or are they able to participate independently?*Please identify any behaviors or special needs and provide our staff members with ways you feel they can best help your participant enjoy their experience with us:*Please list any allergies (food or environmental), Limitations/Restrictions (Activity or Diet):*The participant has permission to (select all that apply; for 13+ participants, only)* Walk Home Bike Home Take the public bus home Ride Share with another student home, please list who they can ride share with below: Not Applicable Please check that you have read and agree to the following:* I have read and understand the Health and Injury Liability Waiver I authorize my child to participate in Children’s Clinics Childhood Experiences Programs. I acknowledge the risks inherent in the participation by my child. In my absence, I further authorize the staff representing Children’s Clinics to act for me according to their best judgment in any emergency requiring medical attention for my child and I hereby waive and release those staffers, and volunteers of Children’s Clinics from all liability for any injuries or illnesses, that may be incurred while participating in Children’s Clinics Childhood Experiences, while in attendance, except for injury directly resulting from gross negligence or willful misconduct. Please check that you have read and agree to the following:* I have read and give consent to the photographing/video recoring of the above-named participants I have read and do NOT give consent. I consent to the photographing/video recording/ audio recording of the above-named patients by Children's Clinics staff at this event. I agree the resulting images or recordings may be used for Children's Clinics publicity or marketing purposes (brochure, pamphlet, lobby display, social media posts, printed material, etc.). I understand that I have the right to reverse this consent, in writing, at any time before the image or recording is used for the purposes indicated above.