Teen Earth Optimism Summit - Anchorage School District€¦ · Calling teens ages 13-17 who want to make our home planet a better place. You are invited to collaborate with the Smithsonian

Teen Earth Optimism Summit8 a.m. to 1 p.m. | Saturday, March 14 | Free

SEED Lab, Anchorage Museum | 109 West 6th Avenue

Calling teens ages 13-17 who want to make our home planet a better place. You are invited to collaborate with the Smithsonian Institution and the Anchorage Museum to address climate change in Anchorage and propose youth-led solutions.

What to expect at the Summit:

• Meet other local teens interested in sustainability and addressing climate change• Listen to a panel discussion by teens who are taking steps to improve water, climate

and environment• Connect with local experts working on different climate change solutions in

Anchorage• Work together to develop and propose a project that can help address climate

change, which Anchorage Museum representatives will present at the Smithsonian’sEarth Optimism Summit in Washington, D.C., April 23-25

• Be empowered to be climate leaders and make positive change

Space is limited. Register now at www.anchoragemuseum.org/youthsummit. Call 907-929-9258 or email [email protected] with questions.

The Anchorage School District does not endorse these materials or viewpoints expressed in them.

Earth Optimism Summit Registration

Email completed form to [email protected] The Anchorage School District does not endorse these materials or the viewpoints expressed in them

8 a.m. to 1 p.m. | Saturday, March 14 SEED Lab, Anchorage Museum | 109 West 6th Avenue NOTICE: Space is limited, and registration is on a first-come, first-served basis. Each registrant will be notified they have a spot in the program or if they are placed on a waitlist. Personal Information Teen Full Name Phone Email

Languages Spoken

Grade Level School

Parent or Guardian Information Name Phone Email

Preferred Language

Name Phone Email

Preferred Language

Emergency Contact Information (adult that is not a parent or guardian): Name Phone Relationship to teen

Preferred Language

Why are you interested in attending the Earth Optimism Summit?

Please read and sign: □ I am between 13-17 years old

□ I will arrive at SEED Lab by 8a.m. on Saturday, March 14.

□ Breakfast will be provided. If I have special dietary needs, I will bring my own food.

_______________________________________ _______________ Signature - Participant Date

Have a parent or guardian read and sign the back --------------->

Registration Terms & Agreements:

Email completed form to [email protected] The Anchorage School District does not endorse these materials or the viewpoints expressed in them

Parent or guardian permission: I agree to allow my child to participate in the Anchorage Museum’s Earth Optimism Summit.

• Departure: At the end of the program, my child may (check one or both)□ Leave on their own □ Leave with any of these adults: ____________

____________________________________

• Media Release: By signing below, I hereby authorize the Anchorage Museum tophotograph or videotape my child and agree that the Anchorage Museum mayindefinitely use or permit other persons to use the negatives, prints, or videotapeprepared for such purposes and in such manner as may be deemed necessary topromote the Anchorage Museum. There may be news coverage of this program, andI allow my child to be filmed or interviewed by local media.

• Release of Liability: I, as parent/guardian of ______________________ (“Child”),represent that I understand the nature of the activities to be undertaken by my Childand hereby assume all risks and hazards incidental to the conduct of the activities atAnchorage Museum Earth Optimism Summit. I hereby represent and certify that myChild is in good health and has no known medical condition that could endanger theirown wellbeing or the wellbeing of others during the Museum programs in which Ihave enrolled him/her.

I hereby release, indemnify, and hold harmless the Anchorage Museum for any claimor liability that may arise out of my child’s participation in any Museum programs,and by executing this WAIVER AND RELEASE, I assume any risk, and take fullresponsibility and waive any claims of, and including any injury, death or damage topersonal property as may occur during transit to and from the program.

I acknowledge that by signing this document I am releasing the Anchorage Museumand its respective affiliates, related entities, directors, employees, agents andvolunteers (collectively “Releasees”) from liability and I hereby release, waive,discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLDHARMLESS the Anchorage Museum and Releasees, from any and all liability, claims,losses and damages to property or to My Child participating in the programs and anyclaim which could not have been anticipated at the time of enrollment in the Museumprogram. This release applies to all activities in which my child engages during theEarth Optimism Summit, regardless of whether such activity is part of a formalprogram.

I understand and confirm that by signing this WAIVER AND RELEASE I have given upconsiderable future legal rights and that no insurance coverage for participants inthese activities is provided by the Anchorage Museum.

_______________________________________ _______________ Signature - Parent or Legal Guardian Date

_______________________________________ Printed Name