Teens are required to be onsite for the duration of Teen Conference from April 5 - 8, 2018. The safety of our Teens is paramount. Since Teens will have to miss school, it is the responsibility of the Teens and their Parents to make special arrangements with their schools in preparation for their absence (i.e. turn in excused absence form to school as soon as Teen Conference registration has been confirmed, make arrangements with the school regarding any assignments or exams that would fall during that time period, notify any sports teams or any other extracurricular activities that your child will be away during that time period.
If there are rare and unique circumstances in which a conflict cannot be avoided or resolved, Teens may request permission from the Regional Director to arrive late or depart early from the Eastern Region Teen Conference, BUT must adhere to the following:
1) No teen may drive to or from the conference or be picked up or returned by another teen
2) An adult who has already been approved by the parent must sign the teen in for late arrival or out for early departure at the POPS office. Identification will be required.
3) For late arrival, the adult must take the teen to the POPs office. The certified chaperone will be called to the office and the teen will be released to the advisor. No teen is permitted to walk to their room unescorted or be in the hotel unescorted.
4) For early departure, a certified chaperone must escort the Teen to the POPs Office and the Teen will be released to an authorized adult.
4) If the teen misses a scheduled waltz rehearsal, he or she will not be permitted to participate in the waltzat the Saturday Gala.
5) If a teen is arriving late or departing early, he or she must be in a triple or quad room, because no Teen can room alone. Teens staying in a double cannot request to leave late or early if they would be away overnight, because the other teen would be forced to room alone—and that is not allowed.
6) The Eastern Region has the right to refuse admittance of a teen if they appear to be under the influence of alcohol or otherwise impaired.
7) The request must be completed and uploaded to the Teen Conference website at: under “Late Arrivals/Early Departures” bySunday, March 4, 2018. The Regional Director is the ONLY person who can, in order to be considered by the Regional Director. The Regional Director is the ONLY person who can grant such permission—and it must be in writing.
Name of Teen:______Chapter______
Name of Mother:______Teen Advisor______
Date and Time of Late Arrival ______OR Early Departure: ______
Reason for Late Arrival:______
Reason for Early Departure: ______
______
Name of Adult Authorized to drop off or pick up Teen:______
Release of Liability, Waiver of Claims and Assumption of Risk and Indemnity Agreement
By signing this document, you will waive certain legal rights, including the right to sue or claim compensation from Jack and Jill of America, Inc., and any member of Jack and Jill of America, Inc. following an accident, injury, or death that may occur from arriving late or departing early from the Eastern Region Teen Conference.
I, ______the undersigned parent or legal guardian acknowledge that I have requested for my child, ______, to arrive late/depart early (circle one) from the Eastern Region Teen Conference on ______and do hereby release Jack and Jill of America, Inc., including all Chapters, its chaperones, its members, or designees from any and all liability which might result from any personal injury claims or cause of action which might result directly or indirectly from my teen’s ______late arrival or early departure from the Eastern Region Teen Conference and participating in any offsite activity not under the supervision of Jack and Jill of America, Inc. I waive any and all claims that I have or may have in the future against Jack and Jill of America, Inc., and its designees. This release agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns, and representatives in the event of my death or incapacity.
I, ______the undersigned parent or legal guardian of ______also understand that if my teen ______is determined at any time to be impaired or under the influence of any controlled substance, that I will be responsible for picking up my child immediately at my expense, and that my teen will not be permitted to participate in the remainder of the conference activities and no refund will be provided. I also understand that my teen, ______will only be dropped off or released to adult named above, who was approved by me, and will only be allowed to arrive late ordepart early from Teen Conference with the adult named above.
I am not relying upon any oral or written representations or statements made with respect to leaving the Eastern Region Teen Conference other than what is set forth in this Agreement.
Signature of Teen:______Date:______
Print Full Name of Teen:______
Signature of Parent/Guardian______Date: ______
Print Full Name of Parent/Guardian______
Telephone Number: ______
For Regional Use Only
Date Received:______Signature of Regional Director______
Teen Confirmed to be in a Triple or Quad Room—Not a Double______
POPs Use Only
Time of Departure by Teen:______Signature of Chaperone______
Signature of Person Signing Teen Out:______
Print Name of Person Signing Teen Out:______
POP Confirmed that person signing is same person on Page 1______
Time of Return by Teen:______Signature of Chaperone______
Signature of Person Returning Teen:______
Print Name of Person Returning Teen:______