1. ACSF will only supervise youth in the building during class times. I am solely responsible for my child’s transportation to and from ACSF\’s studio location.
2. Participation is contingent upon students following ACSF’s expectations and exhibiting positive behavior.  This includes but is not limited to following all COVID-19 safety protocols.  Students who do not follow these guidelines can possibly be suspended or removed from the Summer Camp on a case-by-case basis.
3. Students must respect the space, ACSF staff, and students, and be respectful of any class that is in progress. There are NO DRUGS, NO ALCOHOL, NO WEAPONS OF ANY KIND allowed inside our building at any time. Any member who brings weapons, drugs, or alcohol into the studio or comes to the studio under the influence of drugs or alcohol will be removed from the program. ACSF is a safe space. Anyone who violates or jeopardizes the safety of each other will be removed from the program.
4. I hereby give permission for my child to be photographed, videotaped, and/or interviewed for use by ABADÁ- Capoeira San Francisco (ACSF) in promotional materials.
5. I hereby give permission for my child to participate in scheduled activities that occur off-site at nearby facilities (parks, schools, etc.). I understand that transportation will be provided and that my child will be accompanied by a staff person. I understand that ACSF staff will supervise all activities.
6. I hereby release (for myself, my executors and administrators) and WAIVE any and all rights to claims for damages arising from any illness (including but not limited to COVID-19), accident, or occurrence caused by or as a result of my child’s participation or connection with ACSF, its instructors, agents, representatives, and/or facilities. ACSF, its agents, instructors, representatives, and facilities shall not be held responsible by me for the loss or theft of my child’s belongings. I have been warned that my child must be in good health to participate in this program and I now declare that my child is in good health. I declare that I have read and understood the foregoing statement and that I have either consulted a physician for my child or voluntarily chosen not to consult a physician before starting or during the course of this program.
7. I understand that the City and County of Department of Public Health San Francisco Health Officer allow childcare and summer camps for all families at facilities that follow required safety rules.  This does not mean that attending summer camp is free of risk. Enrolling a child in summer camp could increase the risk of the child becoming infected with COVID-19, RSC, or Flu. While the majority of children that become infected do well, I understand that each parent or guardian must determine for themselves if they are willing to take the risk of enrolling their child in summer camp, including whether they need to take additional precautions to protect the health of their child and others in the household, including household members who are adults 60 years or older, or anyone who has an underlying medical condition. I understand that it is my responsibility to discuss these risks or concerns with their pediatrician or other healthcare providers prior to enrollment.

The San Francisco Department of Children, Youth, and Their Families (DCYF) funds our agency and the services we provide. To fulfill the requirements of this funding, we share information about the participants in our services with DCYF. DCYF relies on the information that we provide to understand the characteristics of participants in our programs and to ensure that San Francisco’s most vulnerable children, youth, and families have access to services across the city. DCYF also uses the data to monitor our funding and to evaluate program activities and impacts.

By signing this form, you allow our agency and any subcontractors we may use to share information about your child’s participation in our program with authorized staff at DCYF. The information that we report to DCYF includes:

• Personal information, such as name, date of birth, and address;
• Demographic information, such as race/ethnicity and gender identity;
• Education information, such as school name and grade level;
• Participation in activities and services, such as dates of participation and number of participation hours;
• Anonymous and voluntary youth experience surveys.

DCYF works in close partnership with the San Francisco Unified School District (SFUSD). The information that we share with DCYF is also shared with SFUSD if it is related to an SFUSD student. Federal and state laws that govern the use and disclosure of student education records protect the privacy of this information. No information shared will ever be publicly reported in a way that may be used to identify you.

Your Rights: You do not have to sign or return this form. If this is the case, we will not share your information with DCYF. Choosing not to share information will not affect your child’s participation in our program. This form will expire on June 30, 2024, the end of DCYF’s current funding cycle, but you may cancel it at any time by informing us in writing. If you cancel your permission, it will go into effect immediately, unless the information has already been shared. You have a right to receive a copy of this form.

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