School or Organization:____________________________ Student: _____________________________________
YMCA Youth in Government
Youth Code of Conduct &
Permission Slip Form
Conference Behavior Agreement 2014-2015
I understand and agree that:
1. Mature and responsible behavior is expected from each delegate. Delegates should
practice the four core values of the YMCA: caring, honesty, respect and
responsibility.
2. Delegates will be expected to adhere to the conference curfew. Those who wish to
discuss the issues prior to curfew may hold evening discussions in the lobby. The
curfew is in effect until 6:00am.
3. No one is permitted to leave the conference grounds. If, for any reason, a delegate
should have to leave, he/she must clear this with the conference office and his/her
advisor.
4. Men will not be permitted in women’s room and women will not be permitted in
men’s rooms.
5. Use of tobacco is not permitted.
6. Any delegate who violates rules #1-5 shall be dealt with on an individual basis at the
discretion of his/her advisor. The State Director shall make the ultimate decision.
Possible penalties include, but are not limited to:
 Suspension of free time
 Loss of proposal sponsorship
 Loss of speaking privileges
 Loss of delegate privileges and departure from the conference
 Loss of elected office
7. There will be no drinking of alcohol beverages or use of drugs for non-medical
purposes. Those in violation of this rule will be asked to contact their parents and
make immediate arrangements for departure.
8. No candles, incense or fire of any sort is permitted in the buildings.
9. Cell phones and all electronic devices must be turned off during sessions.
10.I am aware of the dress code and will abide by it.
Delegate Signature _____________________________ Date: __________
Parent Signature_______________________________________________
Advisor Signature______________________________________________
School or Organization:____________________________ Student: _____________________________________
Permission for Transportation
The YMCA has my permission to transport me to, from and during the YMCA Youth
in Government Conferences.
Authorization for Emergency Medical Care
Person to contact in case of emergency:______________________________
Home Phone (_____)_______________ Cell Phone (_____)______________
If I am out of town, I give my consent for __________________to be taken to the
nearest hospital for treatment.
Hold Harmless Agreement
By my signature, and of my free will, I do hereby agree to indemnify and hold
harmless the YMCA of Greater Oklahoma City from any and all claims or demands,
costs or expenses arising out of any injuries, damages or other losses, whether
personal or property sustained by me or any party to whom I am responsible.
Photo and Video/Audio Recording Release
For my participation in activities conducted by the YMCA of Greater Oklahoma City,
I hereby give permission and consent, now and for all time, to the YMCA of Greater
Oklahoma City, the National Council of Young Men’s Christian Associations of the
United States of America (YMCA of USA) and third parties collaborating with the
YMCA of Greater Oklahoma City and/or YMCA of USA to make, reproduce, edit,
broadcast or rebroadcast any video film, footage, sound track recordings and photo
reproductions of me and/or my dependent. My narrative account of my experience
at the YMCA of Greater Oklahoma City may be used for publication, display, sale or
compensation to, and/or claim. I may, or may not be, identified in such
reproductions; however, I shall not be stated by name to have endorsed a
particular commercial product or commercial service.
By signing below, you are agreeing to all of the above areas: Permission for
Transport, Authorization for Emergency Medical Care, Hold Harmless Agreement
and Photo and Video/Audio Recording Release.
Delegate Signature _____________________________ Date: __________
Parent Signature_______________________________________________
Advisor Signature______________________________________________