Event Dates: July 24-26, 2026 | Location: Southern California (TBD)
Organized by Kaizen Community | youngmensweekend.com | 323-977-8567
IMPORTANT: PLEASE READ THIS ENTIRE DOCUMENT CAREFULLY BEFORE SIGNING.
This Agreement is between the participant's family and Kaizen Community, a 501(c)(3) California Nonprofit ("Kaizen Community"), the 501(c)(3) California Nonprofit that operates the Young Men's Weekend program. It must be completed and signed by the participant's parent or legal guardian for all participants under the age of 18. Participants aged 18–20 may sign on their own behalf. Completion of this Agreement is required for enrollment.
Participant's Full Name: ____________________
Date of Birth: ___ / ___ / ______
Age at Time of Event: ______
T-Shirt Size: ______
Parent/Guardian Name: ____________________
Relationship to Participant: ___________
Parent/Guardian Phone: ____________________
Email: ____________________________
Home Address: _________________________________________
Please provide two emergency contacts who can be reached during the event if parents/guardians are unavailable.
Name | Relationship | Phone
This information is kept strictly confidential and used solely to ensure participant safety during the event.
Allergies (food, environmental, medication): ________________________________________
Current Medications: ________________________________________ Dosage/frequency: __________
Medical Conditions or Physical Limitations: ____________________________________________
Dietary Restrictions: ________________________________________
Health Insurance Provider: ____________________ Policy #: ____________________
Does the participant have any of the following? (Circle Yes or No)
• Asthma / Breathing conditions: Yes / No
• Heart conditions: Yes / No
• Anxiety / mental health conditions: Yes / No
• Recent injuries or surgeries: Yes / No
If yes to any above, please describe: ________________________________________________
By signing this Agreement, the parent/guardian (or participant, if 18+) acknowledges and consents to all of the following on behalf of Kaizen Community, a 501(c)(3) California Nonprofit ("Kaizen Community"):
I consent to the named participant taking part in all scheduled activities of the Kaizen Young Men's Weekend, including but not limited to:
• Obstacle course and physical challenges
• Wilderness fundamentals and outdoor education
• Team-building ropes courses
• Camping, fireside discussions, and overnight stays
• Ceremonies, group discussions, and mentoring sessions
I understand that physical activities carry inherent risk, and I voluntarily enroll the participant with full awareness of these activities.
In the event of a medical emergency and if I cannot be reached, I authorize Kaizen Community event staff to: (a) contact emergency services (911); (b) transport the participant to the nearest appropriate medical facility; and (c) authorize emergency medical treatment deemed necessary by medical professionals. I agree to be financially responsible for any medical expenses incurred.
If the participant requires daily or emergency medication, I authorize trained event staff to assist with medication administration according to the instructions I provide. All medications must be delivered in original labeled containers with written instructions.
I grant Kaizen Community permission to photograph and/or video record the participant during the event. These images and recordings may be used for educational, promotional, and social media purposes (e.g., the @youngmensweekend Instagram). No images will be used in a manner that identifies a minor by full name without explicit additional consent.
☐ I CONSENT to photo/media use ☐ I DO NOT CONSENT to photo/media use
I understand and acknowledge that participation in the Young Men's Weekend involves outdoor and physical activities that carry inherent risks, including but not limited to falls, physical exertion injuries, weather-related discomfort, and emotional challenges related to personal growth work. I voluntarily accept these risks on behalf of the participant.
To the fullest extent permitted by law, I hereby release, discharge, and hold harmless Kaizen Community, a 501(c)(3) California Nonprofit, its officers, directors, staff, volunteers, mentors, and agents (collectively, "Released Parties") from any and all claims, demands, losses, damages, or causes of action arising from the participant's involvement in the Young Men's Weekend, whether caused by negligence or otherwise, except in cases of gross negligence or willful misconduct.
I understand and agree that the participant is expected to:
• Treat all staff, mentors, and fellow participants with respect
• Refrain from any bullying, harassment, or discriminatory behavior
• Abstain from the use or possession of alcohol, tobacco, or illegal substances
• Refrain from bringing weapons, harmful tools, or prohibited items
• Follow all instructions from staff and mentors
• Remain within designated areas unless expressly permitted otherwise
I understand that violation of the Code of Conduct may result in immediate dismissal from the event without refund, at the sole discretion of Kaizen Community.
Cancellations made more than 30 days before the event will receive a full refund. Cancellations made 15–30 days prior will receive a 50% refund. Cancellations within 14 days of the event are non-refundable. Kaizen Community reserves the right to cancel the event due to circumstances beyond its control; in such cases, a full refund will be issued.
By signing below, I confirm that I have read and understood this entire Participant Consent Agreement, and I agree to all terms on behalf of myself and/or the named participant. I understand this Agreement is with Kaizen Community, a 501(c)(3) California Nonprofit.
_______________________________
Parent / Legal Guardian Signature
_______________________________
Date
_______________________________
Printed Name of Parent / Guardian
_______________________________
Participant Signature (if 18+)
_______________________________
Date
For Office Use Only:
Received by: ______________________ Date: __________ Registration #: ________