Youth Program Consent FormDiversified Community Services Creating a positive change for a future of endless possibilities Child's Name First Last Parent's Name First Last Consent(Required)I understand that by signing this agreement, I agree to save and hold harmless and indemnify Diversified Community Services (DCS) the extent permitted by the law from all liability, loss, cost claim or damage whatsoever which may be imposed upon or incurred by said parties because of the participation of the minor in the program and release said parties in this regard on behalf of both the minor and the parents or legal guardians as well. I also grant permission for the use of images and the voice of the student and or parent while the student and or parent is involved in program activities, for promotion of Diversified Community Services (DCS), whether produced by Diversified Community Services (DCS) or commercial media outlets. I agree that my child or myself may take part in data collection methods (surveys, questionnaires, etc.) that will assist the program in determining if my child or myself was satisfied with services and if set expectations and outcomes of the program were met. Further, I understand that Diversified Community Services (DCS) programming is provided at low or no cost through grantor agencies such as the Michigan Department of Health and Human Services, Wayne County Health, Veterans and Community Wellness, the Administration for Children and Families Family, Youth and Services Bureau, and other private and foundation funding. My child’s participation in the program may be funded through one or several of these funding sources. I give consent for my child and or myself to participate in this program.*Signature(Required)EmailThis field is for validation purposes and should be left unchanged.