{"id":20221,"date":"2023-11-16T20:19:56","date_gmt":"2023-11-16T20:19:56","guid":{"rendered":"https:\/\/www.cadca.org\/?page_id=20221"},"modified":"2023-11-16T20:19:58","modified_gmt":"2023-11-16T20:19:58","slug":"cadca-national-leadership-forum-parent-guardian-consent-form","status":"publish","type":"page","link":"https:\/\/www.cadca.org\/fr\/cadca-national-leadership-forum-parent-guardian-consent-form\/","title":{"rendered":"CADCA National Leadership Forum Parent\/Guardian Consent Form"},"content":{"rendered":"<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<style media=\"all\" type=\"text\/css\">\n\n    \/* xs & sm (mobile) *\/\n    @media (max-width: 767.98px) {\n        }\n\n    \/* md (tablet) *\/\n    @media (min-width: 768px) and (max-width: 1199.98px) {\n        }\n\n    \/* lg (desktop) *\/\n    @media (min-width: 1200px) {\n        }\n\n    \/* custom styles *\/\n    <\/style>\n<section class=\"page_intro block_5c189682f4b4d54382d03c81b8b61639\" id=\"block_5c189682f4b4d54382d03c81b8b61639\">\n    <div class=\"container\">\n        <h1>CADCA National Leadership Forum Parent\/Guardian Consent Form<\/h1>\n            <\/div>\n<\/section>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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      <\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/fr\/wp-json\/wp\/v2\/pages\/20221' data-formid='9' novalidate data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/20221\">\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div>\n  <p align=\"center\"><span style=\"font-size:18px;\"><i>2024 CADCA National Leadership Forum<\/i><\/span>\n    <br \/> January 29-February 1, 2024\n    <br \/> 201 Waterfront St. Oxon Hill, MD\n    <br \/> Statement of Informed Consent for Parents\/Guardians<\/p>\n<\/div><\/div><div id=\"field_9_3\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_3'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_9_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_4\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div>\n  <div>\n    <p><span style=\"font-size:16px;\">This parent\/guardian consent form is required for ALL youth attending CADCA&rsquo;s 2024 National Leadership Forum (the &ldquo;Event&rdquo;). <u>&rdquo;CADCA&rdquo;<\/u> is a nonprofit organization headquartered in Alexandria, Virginia whose mission is to create and maintain safe, healthy and drug-free communities globally. CADCA&rsquo;s National Leadership Forum consists of youth and adult training sessions aimed at making coalitions smarter and faster.<\/span><\/p>\n    <p><span style=\"font-size:16px;\">If you agree to have your child participate in this training, they will be expected to participate in a comprehensive training course with their adult advisor who has agreed to assume responsibility for them while traveling and during the event. All data obtained will be treated with the highest level of confidentiality.<\/span><\/p>\n    <p><span style=\"font-size:16px;\">The youth trainings offered is through CADCA&rsquo;s Youth Leadership Courses and our community partners. CADCA&#39;s Youth Leadership Courses enhance the effectiveness of youth and their coalition advisor within community coalitions. It empowers thousands of young people yearly to get involved in the community problem-solving process for the development of safe, healthy and drug free communities.<\/span><\/p>\n    <h2>Photograph\/Video Waiver<\/h2>\n    <p><span style=\"font-size:16px;\">By submitting this form, you give permission to CADCA to <u>use and grant unto CADCA all right, title, and interest in any<\/u> photographs, videotapes, film and audio in &nbsp;which Youth appear as a participant for educational and publicity\/promotional purposes for or related to CADCA&rsquo;s and\/or the coalition&rsquo;s work, including, but not limited to, any donations, proceeds, or other benefits derived from such photographs or recordings. These can also be used by CADCA in published materials.<\/span><\/p>\n    <h2>Permission for Medical Treatment<\/h2>\n    <p><span style=\"font-size:16px;\">I hereby give consent, authorization, and release from liability CADCA and its employees, officers, volunteers, agents, affiliates, partners, event hosts, owners and operators of the premises used to conduct the Event and each of them, their affiliates, partners, agents, and employees (collectively, the &ldquo;Releasees&rdquo;) to secure emergency medical treatment and take appropriate action as needed in the event of an emergency in which the parent\/guardian cannot be contacted, and agree to be responsible for the costs thereof. I acknowledge that CADCA does not provide medical insurance coverage for Youth.<\/span><\/p>\n  <\/div>\n  <h2>General Release of Liability<\/h2>\n  <p><span style=\"font-size:16px;\">You understand that Youth&rsquo;s participation in the Event is voluntary and may expose Youth to risk including but not limited to physical injury, death, and\/or property loss. CADCA does not provide health or accident insurance for Youth, and you understand that any medical expenses, property loss, or other personal expenditures that result during or to\/from this Event are to be borne by yourself. You also understand that Youth&rsquo;s participation in the Event will involve activities off of CADCA property and therefore Releasees will have no responsibility for the condition and use of any non-CADCA property. You further understand that CADCA is not responsible for Youth&rsquo;s supervision during such period of time when Youth may be absent from a CADCA supervised activity.<\/span><\/p>\n  <p><span style=\"font-size:16px;\">You assume full responsibility for any risk of personal or property damages arising out of or related to Youth&rsquo;s participation in the Event, including any acts of negligence or otherwise from the moment that Youth is under CADA supervision and throughout the duration of the Event, and travel to and from the Event.<\/span><\/p>\n  <p><span style=\"font-size:16px;\">You further acknowledge that Youth may be a passenger in another&rsquo;s private vehicle in connection with travel to and from the Event and that CADCA&rsquo;s auto insurance does not cover such private vehicle. You also understand and agree that CADCA is not responsible for assuring the safety and reliability of such private transportation, or driver, nor for any non-sponsored activities and travel that Youth might choose to participate in before, during or after the Event, and you therefore accept the risks and responsibilities associated with such private vehicle travel and activities.<\/span><\/p> <span style=\"font-size:16px;\">In consideration of the opportunity for Youth to attend the Event, with full knowledge and acceptance of the risks association with the Event and any travel to and from the Event, the undersigned agrees to release, waive, discharge, indemnify, and hold harmless the Releasees from any and all claims, suits, losses, or related causes of action for damages during or arising in any way from Youth&rsquo;s participation in this training event. You are being asked whether or not you will permit Youth to participate in this training. If you wish to give permission to participate, and you agree with the statement below, please check the box below.<\/span><\/div><\/div><div id=\"field_9_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_5'>Youth\u2019s Name (First &amp; Last) (referred to herein as \u201cYouth\u201d)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_6\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_6'>Youth&#039;s Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_9_6' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_9_7\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_7'>Youth&#039;s Date of Birth<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_7' id='input_9_7' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_9_7_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_9_7_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_9_7' class='gform_hidden' value='https:\/\/www.cadca.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_9_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Youth Gender<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_10'>\n\t\t\t<div class='gchoice gchoice_9_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Male'  id='choice_9_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_10_0' id='label_9_10_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Female'  id='choice_9_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_10_1' id='label_9_10_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Non-binary'  id='choice_9_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_10_2' id='label_9_10_2' class='gform-field-label gform-field-label--type-inline'>Non-binary<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Prefer not to answer'  id='choice_9_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_10_3' id='label_9_10_3' class='gform-field-label gform-field-label--type-inline'>Prefer not to answer<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Prefer to self-describe'  id='choice_9_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_10_4' id='label_9_10_4' class='gform-field-label gform-field-label--type-inline'>Prefer to self-describe<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_9\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_9'>Describe Youth Gender<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_9_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Race\/Ethnicity of Youth (This allows us to better serve our coalitions, please check all that apply)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_9_11'><div class='gchoice gchoice_9_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Indigenous or Native American'  id='choice_9_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_1' id='label_9_11_1' class='gform-field-label gform-field-label--type-inline'>Indigenous or Native American<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Asian or Pacific Islander'  id='choice_9_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_2' id='label_9_11_2' class='gform-field-label gform-field-label--type-inline'>Asian or Pacific Islander<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Black or African Descent'  id='choice_9_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_3' id='label_9_11_3' class='gform-field-label gform-field-label--type-inline'>Black or African Descent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Hispanic or Latinx\/e'  id='choice_9_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_4' id='label_9_11_4' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latinx\/e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='White'  id='choice_9_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_5' id='label_9_11_5' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Two or more races'  id='choice_9_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_6' id='label_9_11_6' class='gform-field-label gform-field-label--type-inline'>Two or more races<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='Prefer Not to Answer'  id='choice_9_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_7' id='label_9_11_7' class='gform-field-label gform-field-label--type-inline'>Prefer Not to Answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='Other'  id='choice_9_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_11_8' id='label_9_11_8' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_12\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_12'>Self-Describe Race\/Ethnicity of Youth<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_9_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Gender Preference of Youth. Please select all that apply (This allows us to better serve our coalitions)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_9_13'><div class='gchoice gchoice_9_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Straight\/Heterosexual'  id='choice_9_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_1' id='label_9_13_1' class='gform-field-label gform-field-label--type-inline'>Straight\/Heterosexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Gay\/Lesbian'  id='choice_9_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_2' id='label_9_13_2' class='gform-field-label gform-field-label--type-inline'>Gay\/Lesbian<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Bisexual'  id='choice_9_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_3' id='label_9_13_3' class='gform-field-label gform-field-label--type-inline'>Bisexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Queer'  id='choice_9_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_4' id='label_9_13_4' class='gform-field-label gform-field-label--type-inline'>Queer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Asexual'  id='choice_9_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_5' id='label_9_13_5' class='gform-field-label gform-field-label--type-inline'>Asexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Prefer not to say'  id='choice_9_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_6' id='label_9_13_6' class='gform-field-label gform-field-label--type-inline'>Prefer not to say<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.7' type='checkbox'  value='Prefer to self-describe'  id='choice_9_13_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_13_7' id='label_9_13_7' class='gform-field-label gform-field-label--type-inline'>Prefer to self-describe<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_14\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_14'>Self-Describe Gender Preference of Youth<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_9_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_16\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div>\n  <div>\n    <h2>Signatures<\/h2>\n    <p><span style=\"font-size:16px;\">The &#8220;digital signatures&#8221; to be provided below are not actual written signatures, however they are held to the same standards and legality as an official signing. Simply type the requested name into the required space.<\/span><\/p>\n  <\/div>\n<\/div><\/div><fieldset id=\"field_9_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Check all that apply<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_9_15'><div class='gchoice gchoice_9_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='I understand that, in this document, typing a digital signature below holds the same standards and legality as an official signing. I certify that I am the parent and legal guardian of Youth, that I have read and that I understand the above Agreement, and that I accept and will be bound by its terms and conditions on my own behalf and on behalf of Youth.'  id='choice_9_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_15_1' id='label_9_15_1' class='gform-field-label gform-field-label--type-inline'>I understand that, in this document, typing a digital signature below holds the same standards and legality as an official signing. I certify that I am the parent and legal guardian of Youth, that I have read and that I understand the above Agreement, and that I accept and will be bound by its terms and conditions on my own behalf and on behalf of Youth.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='I understand the information provided in this form and I am 18 years of age or older and have read and understand the above statements.'  id='choice_9_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_15_2' id='label_9_15_2' class='gform-field-label gform-field-label--type-inline'>I understand the information provided in this form and I am 18 years of age or older and have read and understand the above statements.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='I understand and agree that Youth\u2019s participation in this Event may be terminated by CADCA at any time in the event Youth fails to follow CADCA rules, policies, or procedures, or for any reason CADCA may deem to be in the best interest of others attending the Event, and that Youth may be sent home at my own expense with no refund. In addition, CADCA may alter activities to enhance individual and\/or group safety.'  id='choice_9_15_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_15_3' id='label_9_15_3' class='gform-field-label gform-field-label--type-inline'>I understand and agree that Youth\u2019s participation in this Event may be terminated by CADCA at any time in the event Youth fails to follow CADCA rules, policies, or procedures, or for any reason CADCA may deem to be in the best interest of others attending the Event, and that Youth may be sent home at my own expense with no refund. In addition, CADCA may alter activities to enhance individual and\/or group safety.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='I certify that Youth is in good physical and behavioral health and has no special medical or physical conditions which would impeded participating in this Event. --OR-- Youth has a special need and instructions are attached.'  id='choice_9_15_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_15_4' id='label_9_15_4' class='gform-field-label gform-field-label--type-inline'>I certify that Youth is in good physical and behavioral health and has no special medical or physical conditions which would impeded participating in this Event. &#8211;OR&#8211; Youth has a special need and instructions are attached.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='I agree to disclose to CADCA any medications (including over the counter\/herbal\/natural) and\/or prescriptions which Youth shall or should take at any time during the duration of the Event.'  id='choice_9_15_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_15_5' id='label_9_15_5' class='gform-field-label gform-field-label--type-inline'>I agree to disclose to CADCA any medications (including over the counter\/herbal\/natural) and\/or prescriptions which Youth shall or should take at any time during the duration of the Event.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_17\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_17'>Parent\/Guardian Name(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_9_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_18\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_18'>Parent\/Guardian Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_9_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_19\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_19'>Primary Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_9_19' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_20\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_20'>Secondary Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_9_20' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_21\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_21'>Adresse e-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_21' id='input_9_21' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_9_22\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_9_22' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_22_1_container' >\n                                        <input type='text' name='input_22.1' id='input_9_22_1' value=''    aria-required='true'    \/>\n                                        <label for='input_9_22_1' id='input_9_22_1_label' class='gform-field-label gform-field-label--type-sub'>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_9_22_2_container' >\n                                        <input type='text' name='input_22.2' id='input_9_22_2' value=''     aria-required='false'   \/>\n                                        <label for='input_9_22_2' id='input_9_22_2_label' class='gform-field-label gform-field-label--type-sub'>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_9_22_3_container' >\n                                    <input type='text' name='input_22.3' id='input_9_22_3' value=''    aria-required='true'    \/>\n                                    <label for='input_9_22_3' id='input_9_22_3_label' class='gform-field-label gform-field-label--type-sub'>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_9_22_4_container' >\n                                        <input type='text' name='input_22.4' id='input_9_22_4' value=''      aria-required='true'    \/>\n                                        <label for='input_9_22_4' id='input_9_22_4_label' class='gform-field-label gform-field-label--type-sub'>\u00c9tat\/Province\/R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_9_22_5_container' >\n                                    <input type='text' name='input_22.5' id='input_9_22_5' value=''    aria-required='true'    \/>\n                                    <label for='input_9_22_5' id='input_9_22_5_label' class='gform-field-label gform-field-label--type-sub'>Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_9_22_6_container' >\n                                        <select name='input_22.6' id='input_9_22_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option 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