Membership Sign Up

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I agree:

That to become a member of the LYS Inc. I agree to be bound by the rules of LYS Inc., Code of Conduct and any other requirements which may be advised from time to time if admitted.

Code of Conduct *

I understand that LYS Inc. has a strict Code of Conduct, and that everybody has the right to feel safe and welcomed within the program. By entering the building, completing this form and engaging in any activity I acknowledge that I have previously read and agree to the Code of Conduct. I Understand if I breach this Code of Conduct, I will receive one warning. If I continue to breach the Code of Conduct, I may be asked to leave LYS Inc. permanently. LYS Inc. may make any determination to request any individual to leave in their sole discretion.

Activities, Events and Excursions (“Activities”)

Activities, Events and Excursions (“Activities”) From time to time LYS Inc. organises onsite and offsite Activities which you may choose to take part in. You agree that you will at all times ensure your guardian, where relevant, is informed for any offsite activities that may involve evening or overnight events and that you will at all times abide by the Code of Conduct. We hope you will take part and enjoy our Activities but we reserve the right to ban any individual who does not abide by the Code of Conduct for or during the Activity.

Video Recording and Safety

You understand that we have video cameras around our premises for the safety and security of both LYS Inc. and all members of LYS Inc. We have the right to record and store your image and all video footage (‘Recordings’) for a reasonable period in compliance with relevant regulations. We will only use and share these Recordings where is it necessary to protect any of our employees, volunteers, contractors or other members or attendees of LYS Inc. We may also be compelled to produce these Recordings by relevant authorities if requested. By signing this consent and attending LYS Inc., you agree to permit us to record and store any Recording of you whilst on our premises.

Liability *

In the event of any loss, injury, or damage to myself, I agree that LYS Inc. and its staff, volunteers and agents will not incur any responsibility or liability, including but not limited to any accident . I understand and agree that I am fully responsible for any participation in any activity even where I may incur a risk of injury or accident. Should medical attention or treatment be necessary or required, I agree to bear any costs incurred.

Sharing of Information and Media Communications

From time to time we may have media attend LYS Inc. for promotional or other purposes or may be asked for images or quotes. By attending LYS Inc., you consent to any media images, quotes or otherwise being included in any promotion or documentary of LYS Inc.. If you do not wish to be included in any promotion or media, please advise LYS Inc. in writing so it can be included on file. • Information provided to LYS Inc. may also be shared with organisations for the purposes of follow up or case management or otherwise where a government authority may compel us to provide it. Please see our Privacy Policy for further information on what information is collected, used and stored.

I consent to future contact for evaluation purposes *

Yes

No

Do you require an Epi-Pen?

Yes

No

Consent *

(if under 18 years a guardian needs to consent for you)

I consent to participating in any activities involved in LYS Inc. programs.

I give consent to being transported to and from LYS Inc. programs

Parent/Guardian Name

First Name

Last Name

Emergency Contact Name

If this is the same as your parent/guardian - leave blank

First Name

Last Name

Marketing

I do not wish to receive marketing updates via email or text.