Welcome Packet


“The might of one The power of many”

AntFarm is located in the heart of downtown Sandy, Oregon. It is a community space helping youth and families connect. We support youth in identifying and achieving their focus and goals. AntFarm is a place where people come together from all walks of life to support each other and no one is left out. AntFarm explores what happens when the might of one becomes the power of many.
Date:*
Name:*
E-mail:*
Home phone if you have one:
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Your cell phone if you have one:
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Facebook?

AntFarm Opportunities

We have three indoor spaces of learning:
1. Axis Learning Center is a study and computer lab with state of the art technology where students with adult mentors & tutors accomplish educational and vocational goals. It is located at 39140 Proctor Boulevard.
2. AntFarm Café and Bakery supports youth development, healthy eating, and sustainability.
3. The Cultural Arts Center off¬ers the community a space to have meetings and to participate in school and community art, poetry, music, and photography projects.

Our outdoor spaces of learning support youth in addressing community need. These outdoor classrooms of experience include:
1. AntFarm Learning Garden is a garden where youth and community members participate in planting, maintaining and harvesting food. It is located one block west of Bluff Boulevard on the south side of Highway 26. (Next to Tollgate Inn and Alpine Village)
2. Mount Hood Farmers Market is a community market sponsored by AntFarm. It is located at 38600 Proctor Boulevard at the AntFarm Outdoors building. (Next to Dairy Queen) The market has a number of local vendors and provides opportunity for youth to assist in market operations.
3. CommunityConnect is a program helping local elders and disabled people to do home management tasks which have become barriers to independent living. CommunityConnect occurs on Saturdays from 9 am – 3 pm. We meet at the AntFarm Outdoors building.
4. AntFarm YouthCore provides work in partnership with public lands and agencies while teaching youth valuable work skills. YouthCore also supports youth in making contact and connection to the wilderness through hiking, backpacking, mountain biking and other outdoor experiences.
Birthday:*
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Last grade level completed:
Patent's or guardian's name::*
Parent's or guardian's phone:*
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How did you hear about AntFarm?:
Interests:
What do want to get out of your involvement with AntFarm?
AntFarm guidelines and expectations Success is a close working effort between the youth, family, community, and AntFarm. AntFarm guidelines and expectations support successful and healthy working relationships.

Expectations

1. Always be respectful 2. Honor confidentiality 3. Be clean and sober when coming to AntFarm 4. Tell us what you are feeling and thinking
5.Show up on time and maintain schedule6. Sign in and out7. Work hard and be happy8. Help Elders and each other

After school tutoring

(Complete if asking for tutoring help and you will be contacted) Tutoring staff are community individuals who freely volunteer their time to help students learn. To schedule a tutor from AntFarm it is important for the student, tutor, and family to agree on a day, time and plan for tutoring. We ask tutors, staff, volunteers and the students to be respectful and committed to all agreements.
Tutoring need
Availability:
Preferred time of day:
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Health background

Please include any allergies, medications or medical conditions that could be important if the student is injured and/or taken to the hospital. This information will be kept confidential and used only to keep AntFarm participants safe and healthy.
1. Check known allergies:
Please list nuts:
Other allergies not listed:
2. Check known medical conditions:
3. Please list current medications, dosages, and times of day taken:
4. Please identify health insurance information:

Youth and Parent (Guardian) Agreement for Participation and Safety

Participation in all AntFarm activities is voluntary. We want to ensure youth and families that our staff and volunteers provide all activities in a safe and appropriate manner so ask that the following five agreements and information are reviewed.

1. Consent for participation
Participants name:*
Age:*
Birthdate:*
I give my permission for participation in all the activities of AntFarm. I understand that participation in AntFarm may require travel to training sites. I give my permission to ride in an AntFarm van with other AntFarm participants during AntFarm activities.
2. Consent for medical treatment

I agree that immediate medical attention may be provided in the event an accident or illness that occurs during AntFarm program hours. If an accident occurs on a site, I further understand that the participant will be taken for treatment to a physician or to the emergency room of the nearest hospital. Every reasonable attempt will be made to inform the below emergency contacts.
3. Acknowledgement of Responsibility, Assumption of Risk and Release of Liability

I understand that during my participation in AntFarm Outdoors Programs (YouthCore, Outdoor Adventure, CommunityConnect, and AntFarm Learning Garden), I may be exposed to a variety of hazards and risks, foreseen or unforeseen, which are inherent in each activity and cannot be eliminated without destroying the unique character of the AntFarm activity. These inherent risks include, but are not limited to, the dangers of serious personal injury, property damage, and death. AntFarm has not tried to contradict or minimize my understanding of these risks. I know that Injuries and Damages can occur by natural causes or activities of other persons, animals, trip members, trip leaders and assistants or third parties, either as a result of negligence or because of other reasons. I understand that risks of such Injuries and Damages are involved in AntFarm travel and I appreciate that I may have to exercise extra care for my own person and for others around me in the face of such hazards. I further understand that on particular activities, there may not be rescue or medical facilities or expertise necessary to deal with the Injuries and Damages to which I may be exposed.

In consideration for my acceptance as a participant on this AntFarm Outdoor programs including YouthCore, Outdoor Adventure, CommunityConnect, and the AntFarm Learning Garden, and the services and amenities to be provided by AntFarm in connection with these activities, I confirm my understanding that:

• I have read the AntFarm Welcome Packet, reviewed any rules and conditions applicable to AntFarm Activity, and I acknowledge my participation is at the discretion of the leader.

• The Activity officially begins and ends at the location(s) designated by AntFarm and does not include carpooling, transportation, or transit to and from the Activity, and I am personally responsible for all risks associated with this travel. This does not apply to transportation provided by AntFarm during the Activity.

• If I decide to leave early and not to complete the Activity as planned, I assume all risks inherent in my decision to leave and waive all liability against AntFarm arising from that decision. Likewise, if the leader has concluded the Activity, and I decide to go forward without the leader, I assume all risks inherent in my decision to go forward and waive all liability against AntFarm arising from that decision.

• This Agreement is intended to be as broad and inclusive as is permitted by law. If any provision or any part of any provision of this Agreement is held to be invalid or legally unenforceable for any reason, the remainder of this Agreement shall not be affected thereby and shall remain valid and fully enforceable.

• To the fullest extent allowed by law, I agree to WAIVE, DISCHARGE CLAIMS, AND RELEASE FROM LIABILITY AntFarm, its officers, directors, employees, agents, and leaders from any and all liability on account of, or in any way resulting from Injuries and Damages. I further agree to HOLD HARMLESS AntFarm, its officers, directors, employees, agents, and leaders from any claims, damages, injuries or losses caused by my own negligence while a participant on the outing. I understand and intend that this assumption of risk and release is binding upon my heirs, executors, administrators and assigns, and includes any minors accompanying me on the Activity.

• I have read this document in its entirety and I freely and voluntarily assume all risks of such Injuries and damages and notwithstanding such risks, I agree to participate in the Activity.

Information to help understanding of liability waivers & photo release
Question:Why is AntFarm using a liability waiver?
Answer:Our insurance company requires it. The use of liability waivers have become a standard practice in the outdoor industry. Customers are now required to sign a waiver when doing anything from renting a kayak to going horseback riding. Waivers are used to help protect the outdoor organization and leaders in the event of a lawsuit.
Question:Why is AntFarm using a photo release?
Answer:This is used to ensure participants understand the use of photos so there are no claims such as defamation or invasion of privacy. The person who signs the release gives up any right to sue over these claims.
Question:Can minors sign the liability waivers and photo release?
Answer: No. Liability waivers signed by minors are not enforceable. Minors must have a liability waiver signed by their parent or guardian. Anyone under 18 years old is considered a minor.
4. Publicity and Photo Release I give permission for my photo(s) or video footage (or my child’s, in the case of a minor) to appear in publicity designed for the purpose of informing other agencies and the community about AntFarm activities. I hereby grant AntFarm permission to use my likeness in a photograph accompanied by a story and/or quote about me in any of its publications, social media, and website entries, without payment or any other consideration.

I hereby hold harmless and release and forever discharge the above agencies from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. 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 to choose either the option to give permission or the option to not give permission.

5. Authorization for the Release of Information

To/from: AntFarm Inc.

To/from the following record holders and community partners:
• Clackamas Community College
• Clackamas County Juvenile Department
• Clackamas County Mental Health
• Clackamas Education Service District (ESD)
• C-TEC Youth Services
• Estacada School District
• Housing Authority of Clackamas County
• Job Corps
• Mount Hood Community College
• Oregon Department of Human Services (DHS)
• Oregon Office of Vocational Rehabilitation Services (OVRS)
• Oregon Trail School District
• Oregon Youth Authority (OYA)
• Workforce Investment Board of Clackamas County
• Worksource Clackamas
other:
This authorization includes the release of information consisting of: all pertinent social, educational, employment, alcohol and drug, and mental health information for the purpose of: eligibility determination, assessment, case management, and coordination of services related to education and employment. This authorization includes the release of information consisting of: all pertinent social, educational, employment, alcohol and drug, and mental health information for the purpose of: eligibility determination, assessment, case management, and coordination of services related to education and employment.

I agree that the agencies and individuals listed above may share and exchange information about me and circumstances.

I can cancel this authorization for release at any time, but I understand that the cancellation will not affect any information that was already released before the cancellation. I understand that the information about my case is confidential and protected by state and federal law. I approve the release of this information. I understand what this agreement means. I am signing on my own and have not been pressured to do so.

By marking this box on the electronic Welcome Packet I understand that I give my permission for participation in AntFarm activities. With this signed Welcome Packet, AntFarm staff will contact you to clarify any questions. We also invite you to stop in or call us.

Specifically I agree to:

1. Consent for participation
2. Consent for medical treatment
3. Acknowledgement of Responsibility, Assumption of Risk and Release of Liability
4. Publicity and Photo Release
5. Authorization for the Release of Information
By checking the boxes below you agree to these statements:*
Agreement Date:*

How do we pay for helping young people at AntFarm?

If an individual is willing to work hard to better themselves and their community, we believe they deserve a chance. In an effort to provide learning opportunities, we do not charge for our services and feel strongly that we are to offer this support without barriers. We do, however, have a lot of costs to doing our work. Each year it costs us over $20,000 in insurance and $50,000 in rent/utilities to keep our doors open. We accept donations as a way to support our youth programs. Community members who give donations or volunteer time helps us continue free services. If you would like to support youth in AntFarm projects and activities, we are grateful. Here are the services we offer for free and how your donations can help: 1. Tutoring our youth to learn and be successful in school 2. Helping senior citizens with home management tasks they cannot do 3. Growing food for the community and giving it away to people who need it 4. Volunteering in community events 5. Job skills training for youth

Community Support PledgeCenter

To show my support, please contact me so that I can learn how to:
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