MAS Youth Revive Registration Form Logo
  • MAS Youth Revive Registration

    Complete the form below to sign up for our membership service. Spots are limited.
  • Basic Information

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  • Parent/Guardian Information

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  • Emergency Contact Information

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  • Allergies/Health Conditions

  • Rules and Regulations

  • Zero Tolerance Policy

    Every Youth Leader, Youth Coordinator, or staff member in the Youth Development Program shall have the right to exercise the same authority as to conduct and behavior over the pupils attending the program.

    As with any other zero-tolerance policy, there will be consequences for the following types of misconduct:

    1.  Failure to follow rules, policies and procedure of MAS Youth Revive.

    2. General misconduct, including loud or boisterous behavior that tends to disturb other members, and includes running in the classroom/halls, minor defacement of property, and pushing or shoving others.

    3. A members' persistent refusal to follow the instructions of program staff, program administrators, or any revive employee or volunteer.  This shall also include a member’s refusal or failure to properly identify oneself on request. 

    4. Use of obscene, vulgar, profane, disrespectful, demeaning or threatening words and/or actions or gesture directed to or in the presence of any member or Revive employee.

    5. Mutual physical confrontations between member's (fighting).
      Possession and/or use of any tobacco or drug related items or ‘look a like’ items – this may include cigarettes, chewing tobacco and other tobacco-related products, lighters, alcoholic substances, drug-consumption devices, and any substance suspected of being a ‘drug’.

    6. A behavior that may result in physical or mental abuse to one’s self.
      Committing an act of indecent exposure in the presence of any other member or staff.

       

  • Disciplinary Actions

    Failure to follow rules, policies, and procedure of MAS Youth Revive will result in disciplinary action. 

    Disciplinary actions will be carried out according to the following procedure:

    1. Verbal reprimand.

    2. Special assignments or removal from activity or lesson.

    3. Parent contact.

    4. Suspension from program.

    5. Permanent withdrawal from program.

  • Attendance Policy

    Neither MAS San Diego Employees or MAS Youth Revive Staff can be held responsible for students and families who neglect to follow the attendance procedures in place.  As a result of our need to ensure the safety of our members, as well as the goals of our program, the following policies must be followed:

    1. Members enrolled in MAS Youth Revive are expected to attend on all scheduled program days including hikes and field trips.

    2. If a member is not going to be attending on a regularly scheduled day, we asked that Program Staff be notified by 1:00 pm (858-248-9635) that day or prior to the absence.

    3. Failure to attend three regularly scheduled days without notification to the Youth Leader or any other program staff will result in the member being placed on suspension from MAS Youth Revive, until the issue of non-attendance is addressed by the Youth Coordinator and the parent/guardian. Notification of suspension will be conducted by phone.

    4. Inconsistent or lack of attendance will result in the member’s name being removed from the attendance roster. Notification for attendance roster removal will occur by phone or written correspondence.

  • Privacy and Confidentiality Practices

  • Confidentiality Policy

    It is the policy of MAS Youth San Diego to protect the confidentiality of its participants and their families. With the exception of the limitations listed below, program staff will only share information about members and their families with other professional staff and. Furthermore, all prospective members and parents/guardians should be informed of the scope and limitations of confidentiality by program staff. 

    In order for MAS Youth Revive to provide a responsible and professional service to participants, it is necessary to ask members and parents/guardians to divulge extensive personal information about the prospective members and their families, including:

    • Information gained during program participation. 
    • Members’ names and images gained from participants themselves, program meetings, training sessions, and other events.

     

  • Liability and Injury Release

  • Liability Release and Parental Consent Form

    In consideration of the acceptance of my application for the above program, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in MAS Revive. This release is intended to discharge in advance MAS San Diego, its officials, employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees.

     

  • Consent for Treatment

    I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that MAS Revive will provide no medical insurance for such treatment, and that the cost there of will be at my expense.

     

  • Electronic Signature

  • Submission of the application does not guarantee you a spot in our program. We will contact you shortly to complete your membership application if a spot is available. 

    Thank you!

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