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this Notice and Authorization Concerning Consumer and Investigative Consumer Reports, which you should read carefully, has been provided to you because gpys (Organization) may request a criminal background report in connection with your application for employment, position as a volunteer, or at any time during the course of employment with the Organization, if any, for purposes of evaluating your suitability for employment, promotion, reassignment or retention as an employee. Additionally, in the event that claims or disputes between you and gpys are filed with any third parties, the organization may request investigative reports for purposes of evaluation and response, regardless of whether you remain in the employed with the Organization at the time such claims or disputes arise. The types of reports that may be requested from any registry under this policy include, but are not limited to, criminal records checks including sex offender registries, court records checks, driving records, and/or summaries of educational and employment records and histories, and possibly credit checks.

Please note: gpys will maintain the complete confidentiality of all information obtained through criminal background checks, reference checks, and all information on application forms, including information regarding disqualification decisions.

gpys is an equal opportunity employer and does not discriminate in recruitment, hiring or other terms or conditions of employment on the basis of gender, gender identity, sexual orientation, religion, age, marital status, citizenship, national origin, ethnic identity, veteran status, disability or any other status protected by law.

Authorization I have carefully read and understand this notice and authorization form and, by my signature below, consent to the release of criminal background search reports, as defined above, to gpys (1) in conjunction with my application for employment, (2) during the entire course of my employment or position as a volunteer, if any, and (3) after any such employment ends. I further understand that any and all information contained in my Volunteer application or otherwise disclosed to gpys by me before, during or after my employment, if any, may be utilized for the purpose of obtaining the criminal background search reports requested by the Organization and confirm that all such information provided in connection with my application is true and correct.

I understand and acknowledge that nothing in this notice and authorization is intended to be, or is, a guarantee of employment or a promise of continued employment. If employed by gpys, my employment will not be for a specified period of time and can be terminated at any time for any reason, with or without cause or notice, by me or gpys.


1. THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE The Family YMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the

releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with The Family YMCA.

2. I THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about The Family YMCA premises or in any way observing or using any facilities or equipment of The Family YMCA or participating in any program affiliated with The Family YMCA whether caused by the negligence of the releasees or otherwise.

3. I THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of The Family YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with The Family YMCA.

4. PHOTO RELEASE: I understand that images, video and audio is often used by gpys for promotional purposes. I hereby give my permission and consent, now and for all time, for gpys and third parties collaborating with gpys to make, reproduce, edit, broadcast or rebroadcast any video film, footage, sound track recordings and photo reproductions of me and/or my narrative account of my experience with gpys, for publication, display, or exhibition thereof in promotions, advertising and legitimate business uses without any compensation to, and/or claim, by me. I may, or may not be, identified in such reproductions; however, I shall not be stated by name to have endorsed any particular commercial products or commercial services.

5. By participating in gpys, I agree to release gpys and its independent and autonomous member associations, including gpys member's family, in the United States and around the world from claims of negligence for bodily injury or death in connection with the use of gpys programs and participation in gpys services, and from any liability for other claims, including loss of property, to the fullest extent of the law.


I THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of New Mexico, and all other states, that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the fore going written agreement have been made.

I HAVE READ AND UNDERSTAND THIS DOCUMENT AND RELEASE. Date: Signature of Parent/Guardian: Print Name: gpys conducts regular sex offender screenings on all members, participants and guests. If a sex offender match occurs, gpys reserves the right to cancel membership, end program participation, and remove visitation access to gpys services.

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