Rainbow CHYPs Registration

Where Creativity and Identity Coalesce

Rainbow CHYPs is more than a program—it is a community. Designed specifically for LGBTQIA+ youth, Rainbow CHYPs offers a safe and inclusive space for self-expression, healing, and personal growth.

We are honored to have Stefan Campbell, a creative director in fashion, music, and film for three decades, and Lisa Freeman, actor and author of Honey Girl and Riptide Summer, as the Co-Directors of Rainbow CHYPs.

This is a 6-week online program facilitating open and meaningful conversations about creative experiences, fostering thought-provoking discussions and a sense of belonging. Participants will also hone their skills and discover new forms of creative expression in conversations with musicians, artists, actors, fashion experts, activists, and others who will share their experiences as creatives. 

There will be an opportunity to exhibit and share work in a weekly online gallery, if the participant chooses.

Join us as we embark on a journey of discovery, celebrating the beauty of diversity and the healing power of creativity.

Rainbow CHYPs Pilot Program
Zoom opens at 6:45 pm PT | Session starts promptly at 7 pm PT 
Wednesday, August 30, 2023 
Wednesday, September 6, 2023
Wednesday, September 13, 2023
Wednesday, September 20, 2023
Wednesday, October 4, 2023
Wednesday, October 11, 2023

Registration Form

Participant First & Last Name:
Preferred Name:
Gender:
Pronouns:
Age:
Participant's Email (if applicable):
Parent/Guardian Name:
Parent/Guardian Phone Number:
Parent/Guardian Email:
Emergency Contact Name:
Emergency Contact Phone Number:
Does the participant have special needs that will require accommodations during CHYP's Zoom-based session. If yes, please explain::

WAIVERS & INFORMED CONSENT

By signing this form, I, as parent/guardian, permit CHYP to use pictures of my child(ren) as a program participant in promotional literature, videos, and the CHYP website. I understand my child(ren)’s last name(s) will not be published and I have the opportunity to submit a nickname or alias to be used to replacemy child’s first name. I, as parent/guardian of (“Child”), hereby assume all risks and hazards incidental to the conduct of the activities at CHYP. My Child is fit for the program(s) in which I have enrolled them. I HEREBY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS RELEASEES FROM EVERY CLAIM AND ANY LIABILITY THAT I OR MY CHILD MAY ALLEGE AGAINST RELEASEES (including reasonable legal fees and costs) AS A DIRECT OR INDIRECT RESULT OF INJURY OR DEATHTO ME OR MY CHILD BECAUSE OF MY CHILD’S PARTICIPATION IN ANY CHYP PROGRAMS, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERS TO THE MAXIMUM EXTENT PERMITTED BY LAW. I PROMISE NOT TO SUE RELEASEES ON MY BEHALF OR ON BEHALF OF MY CHILD REGARDING ANY CLAIM ARISING FROM OR RELATED TO MY CHILD’S PARTICIPATION IN ANY CHYP PROGRAM(S). I ACKNOWLEDGE THAT, BY SIGNING THIS DOCUMENT, I AM RELEASING CHYP REPRESENTATIVES, AGENTS, EMPLOYEES, VOLUNTEERS, MEMBERS, SPONSORS, PROMOTERS, AND AFFILIATES (COLLECTIVELY “RELEASEES”) FROM LIABILITY, AND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS. THIS SIGN UP AND RELEASE FORM IS A CONTRACT WITH LEGAL AND BINDING CONSEQUENCES AND IT APPLIES TO ALL ACTIVITIES IN WHICH MY CHILD ENGAGES DURING THE PROGRAM AT CHYP, REGARDLESS OF WHETHER SUCH ACTIVITY IS A PART OF A FORMAL PROGRAM. I HAVE READ THIS RELEASE CAREFULLY BEFORE SIGNING. I UNDERSTAND WHAT THIS RELEASE MEANS AND WHAT I AM AGREEING TO BY SIGNING. I understand that no insurance coverage for participants in these activities is provided by CHYP (Parent or guardian signature):

RULES & AGREEMENTS

My Child(ren) will comply with ALL CHYP Program rules, both written and as stated to him/her/them by CHYP during his/her/their participation in Activities. MyChild(ren) will obey the CHYP staff in regards to those rules as they affect his/her/their safety, other participants and observers. I have read this agreement, understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance ofany nature, and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law on behalf of myself and my Child(ren). Ialso agree that if any portion of this Agreement is held to be invalid, illegal, or unenforceable, that portion of this Agreement shall be deemed separate, distinctand independent, and shall be ineffective to the extent it (I) invalidates the remaining provisions of this Agreement under applicable law or (ii) affects thelegality, validity or enforceability of this Agreement. I certify that I am at least 18 years of age and that no other representations have been made to me thatchange, alter, or modify anything within this Agreement. Additionally, I give CHYP permission to use in its marketing materials any picture in which my Minor Child(ren)’s likeness appears unless I notify CHYP in writing otherwise. CONSIDERATION I acknowledge the personal benefits accruing to my child by reason ofparticipation in the CHYP Program and am aware of the activities which my child will be involved through said participation. RELEASE/INDEMNIFICATION I hereby, inconsideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge,hold harmless and covenant not to sue CHYP, and CHYP Programs, its directors, employees, agents, volunteers, and affiliates from any and all present or futureliability, claims, demands, actions or rights of action, whether asserted by me or a third party arising out of my child's participation in the event activities (the"Claims"). I agree to indemnify and hold harmless CHYP Programs for any such Claims brought by me or a third party from any costs associated with defending orlitigating such claims, including but not limited to attorney fees, costs and legal expenses. TECHNOLOGY AUTHORIZATION ADDENDUM I acknowledge that during my child'sparticipation in the program that certain risks do exist. These include, but are not limited to, the hazards of handling electronics and risks associated with access to the Internet (viruses/malware). In consideration of this acknowledgement, I voluntarily have and do hereby assume all risk associated with my child'sparticipation in this program. UNDERSTANDING: I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a mediation organization for binding resolution. (Parent or guardian signature)::

MEDIA RELEASE FORM

I grant permission to Creative Healing for Youth and Pain (CHYP), hereinafter known as the “Media” to use my/my child’s image(s) (photographs and/or video), voice, testimonials, first name (or alias), age, and diagnosis (optional) for use in Media Publications including ::
All media (everything below):
All social media (Facebook, Instagram, Twitter):
CHYP Videos:
CHYP Newsletters:
CHYP Fundraisers:
CHYP Website:
I hereby waive any right to inspect or approve the finished and/or edited photographs, screenshots, videos, stories, or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown. I waive any right to royalties or other compensation arising from or related to the use of the image, video, or other personal identifying information that you provide (including but not limited to; name, age, diagnoses, story,etc.). I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions to admin@mychyp.org or calling 818-671-0620 prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. I am the parent or legal guardian of the child named below. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions to admin@mychyp.org or calling 818-671-0620 prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. (Parent or guardian signature):
Parent or guardian name:
Date:
Participant's Signature: