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Co-op Youth Ambassador Application
Name
First Name
Last Name
High School
Contact
Email
Phone
Address
City/Town
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Alabama
Alaska
American Samoa
Arizona
Arkansas
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Maryland
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Any medical condition(s) we should be aware of?
I want to be a Youth Ambassador because:
I agree to the following:
As the participating student, by hitting submit I agree to follow these rules: I will remain in the designated areas of all activities and will not leave the premises unless arrangements are made with the Riverland Energy staff and my parents. I understand that no alcoholic beverages or any illegal substances will be allowed. I understand that Riverland Energy may take photographs of participants and activities. I agree that Riverland Energy shall be the owner of and may use such photographs relating to the promotion of future programs. I relinquish all rights that I may claim in relation to use of said photographs. I understand that due to Covid-19, this program will be modified to provide a safe environment for students and may be canceled at any time. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending an event or meeting and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I agree not to sue, discharge, and hold harmless Riverland Energy Cooperative, it’s employees, or directors of and from the Claims. I understand that this program is strictly voluntary.
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