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Personal Information

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The agreement boxes must be checked at the end of each section, and the summary authorization must be completed for the application to upload.

If the volunteer applicant is under age 18, a parent, guardian, or guardian in loco parentis (for international students) must sign the statement at the end of this application 1) verifying the minor understands the document and 2) extending the releases, consents, and waivers to the parent or guardian themselves, and to any and all children they have or are guardians of, who might attend any KEEN event or program at any time.

Screening and Monitoring Agreement

I hereby acknowledge that I have received a copy of (or access to) KEEN's Volunteer Screening and Monitoring Policy (located here) and confirm that I have read and understand the terms of the Volunteer Screening and Monitoring Procedures. I agree, as the KEEN volunteer applicant, to be subject to the terms of the KEEN Volunteer Screening and Monitoring Procedure including the reference check process outlined above.

I also certify that I have never been convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape, or any sexual offense, nor have I ever been ordered to a court to receive psychiatric or psychological treatment in connection therewith.

I authorize KEEN to verify the accuracy of all statements herein and release KEEN from liability in connection with the same. I understand that the above references may be contacted by a KEEN representative if I become a regular KEEN volunteer.

*I represent that I am at least 18 years of age, have read and understand the foregoing Volunteer Screening and Monitoring Procedures, and am competent to execute it, and have provided complete and truthful information on this application. I agree to be bound by its terms.

Publicity Release

I do hereby consent, agree and give permission to KEEN, and their officers, directors, employees, agents and volunteers, to take photographs and make, videotape, audiotape or digital recordings of me at KEEN Events and to use, reproduce, exhibit, publish and otherwise exploit my likenesses, name, voice, statements, personal stories and biographies (collectively, “Likeness”), alone or with others, in any and all media, now or hereafter known, throughout the world in perpetuity for promotional, publicity, training and similar purposes. The Likeness may be altered or modified in KEEN's and/or its Affiliates' sole discretion. I waive any opportunity or right to inspect or approve any such use or exploitation of the Likeness. I agree that all materials created by or for KEEN and/or its Affiliates are the sole property of KEEN or its Affiliates (as relevant), including all copyrights therein. To the extent any Likeness may contain any matter subject to copyright protection in which I claim rights, I hereby assign to KEEN and its Affiliates all right, title and interest, including copyright, in such matter in any and all media, now or hereafter known, throughout the world in perpetuity.
I, on behalf of my and my Children's heirs, estates, insurers and assigns, irrevocably release and discharge KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, from any claims or liability of any kind arising from the making, use, reproduction, publication, marketing or other exploitation of the Likeness, and any alteration or compilation thereof. I waive any rights, claims, or interest that I may have to control the use of the Likeness in any manner or in whatever media used. I understand that there will be no financial or other remuneration to me for creating or exploiting the Likeness.
I, and on behalf of my and my Children's heirs, estates, insurers and assigns, will indemnify and hold harmless KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, from and against any losses, actions, claims, damages, or expenses of any kind, including without limitation attorneys' fees and costs, which may be incurred by or asserted against or by any of them, by any Participant or any third party, arising from or relating to (i) the making, use, publication, marketing or other exploitation of the Likeness in any manner whatsoever. This indemnity and obligation to defend and hold harmless shall survive any termination of this Release or the parties' activities hereunder.

I represent that I am at least 18 years of age, have read and understand the foregoing Publicity Release, and am competent to execute it. I agree to be bound by its terms.

Privacy Policy

I hereby acknowledge that I have received a copy of (or access to) KEEN's Privacy Policy (located here) and confirm that I have read and understand the terms of the Privacy Policy. I agree that I, as a KEEN volunteer, shall abide by KEEN's Privacy Policy in its entirety, taking all reasonable measures to restrict the use and disclosure of Protected Information in accordance with the law and KEEN's Privacy Policy. As part of this overall commitment, I agree that I, as a KEEN volunteer, shall:

not share any information concerning any athlete's health or medical information, including but not limited to information contained in the athlete profile, outside of a KEEN session or in any way unrelated to KEEN.
not contact a KEEN athlete at their home, school, place of work or any other setting outside of KEEN without the parent or guardian's express written permission.
when discussing participation in any KEEN program, be mindful of the need to protect the privacy and identify of KEEN athletes and their families.

I represent that I am at least 18 years of age, have read and understand the foregoing Privacy Policy, and am competent to execute it. I agree to be bound by its terms. I will return all athlete profiles to the session coordinator at the conclusion of each KEEN session.

Liability Release

I, the undersigned, on behalf of myself and on behalf of my and my Children's heirs, estates, insurers and assigns, agree that Kids Enjoy Exercise Now, Foundation Inc. and its Affiliates, (KEEN) shall not be responsible or liable for, and irrevocably release and discharge KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, from any claims or liability of any kind arising from any losses, damages or injuries (including death) to persons or property of any kind resulting, in whole or in part, directly or indirectly, from attendance at or participation in any Event, including without limitation, during travel or transportation to or from an Event whether by transportation provided by KEEN or its Affiliates or any other means. This indemnity and obligation to defend and hold harmless shall survive any termination of this Release or the parties' activities hereunder.

I UNDERSTAND THAT IF I AM INJURED IN THE COURSE OF THE PROJECT, I AM NOT COVERED BY KEEN’s WORKERS’ COMPENSATION PROGRAM. I authorize KEEN to seek emergency medical treatment on my behalf in case of injury, accident or illness to me arising from my involvement as a volunteer. I understand that I will be responsible for medical costs incurred by such accident, illness or injury.

I will volunteer of my own free will, without promise, expectation, or receipt of remuneration. I am not an employee or agent of KEEN for any purpose and my services are not controlled nor mandated by KEEN and/or its Affiliates, hereafter referred to as KEEN.
If I am under the age of 18, I may only participate in volunteer service with the express written consent of my parent or guardian (or in the case of international students, guardian in loco parentis).
I understand and agree that it is possible that I may be injured or otherwise harmed during volunteer service due to accidents, acts of nature, my own negligent or intentional acts, or the negligent or intentional acts of others; that while KEEN has taken some steps to reduce the chances of injuries or harm to me, that KEEN has no control over most risks, and, thus, cannot and does not guarantee nor take any responsibility for the safety of me or my property while I am engaged in volunteer service; and that the I must take full responsibility for myself and assume the risk of harm or damage while serving by taking all necessary and reasonable precautions and acting in a manner that will help protect myself and my property.
I agree to waive and release KEEN from any and all potential claims for injury, illness, damage, or death which I may have against KEEN that might arise out of my service and to hold KEEN harmless there from.
I agree and understand that injuries or losses to others, such as other volunteers or the KEEN athletes, may occur as a result of my negligent or intentional acts during volunteer service, and that to avoid such harm, I must exercise care and act responsibly in serving others.
If any injury or loss to another does occur due to my intentional actions or due to my negligent actions arising outside of the scope of my activities, I must accept the liability for and repair, or make reparations for, the harm done.
KEEN is not providing me with insurance coverage for any injuries, conditions, or losses to me arising out of volunteer activities.
I must maintain my own primary medical insurance and automobile liability insurance when driving to cover potential medical and other costs related to the volunteer service; and I am also encouraged to maintain property and life insurance coverage while serving as a volunteer.
All costs for injury or loss above the coverage provided by my insurance are my personal responsibility.
In any project where I will be transporting others in a vehicle provided by me, I will be required to provide proof of automobile insurance in order to participate.
Since volunteers are not KEEN employees, KEEN does not provide workers’ compensation coverage for injuries or illnesses to me arising out of my activities.

I understand that the materials and tools provided by KEEN are and remain the property of KEEN, and I agree to return these tools and any remaining materials to KEEN at the end of my volunteer service.

I represent that I am at least 18 years of age, have carefully read and understand the foregoing Release of Liability, and am competent to execute it. I agree to be bound by its terms.

Signed

Regarding the releases granted herein, I expressly waive California Civil Code § 1542, or any other statute of similar import or effect, that otherwise may exclude unknown claims from this release. I acknowledge that I am familiar with the provisions of California Civil Code § 1542, which provides as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.” Being aware of said code section, I hereby expressly waive any rights I may have thereunder, as well as any other statute or common law principles of similar effect.

*I have read and understand the above representation concerning the KEEN Volunteer Liability Release, Publicity Consent, Volunteer Screening and Monitoring Procedures, and Privacy Policy.

My check in the box by each agreement and below signifies my agreement to (1) the terms of the Liability Release, (2), the terms of the Publicity Release, (3) be subject to the KEEN Volunteer Screening and Monitoring procedure, and (4) to abide by the Privacy Policy.

Parental Approval

Background Information

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References

Reference *		Order
	Name * Title Title First Name * First Name * Middle Middle Last Name * Last Name * Relationship to you * What relation is this person to you: teacher, coach, etc.? Email * You must supply an email address for each reference. Phone At least two references are required. References should not be either family members or peers. Reference Checked	Weight for row 1
	Name * Title Title First Name * First Name * Middle Middle Last Name * Last Name * Relationship to you * What relation is this person to you: teacher, coach, etc.? Email * You must supply an email address for each reference. Phone At least two references are required. References should not be either family members or peers. Reference Checked	Weight for row 2

Reference 1 (Legacy)

Reference 2 (Legacy)

Reference 3 (Legacy)

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Affiliation	Order
	Affiliation	Weight for row 1

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