AccessCon NYC 2026 – Young Adults Empowerment Conference
World Trade Center | New York, NY 10007

This form must be completed by a parent or legal guardian for any participant under 18 years of age.

1. Participant Information

Participant Full Name: __________________________________________________________________

Date of Birth: _________________________________________________________________________

Age at Time of Event: __________________________________________________________________

Address: ____________________________________________________________________________

City/State/Zip: ________________________________________________________________________

2. Parent / Legal Guardian Information

Full Name: ___________________________________________________________________________

Relationship to Participant: ______________________________________________________________

Phone Number: _______________________________________________________________________

Email Address: _______________________________________________________________________

Emergency Contact (if different): _________________________________________________________

Emergency Contact Phone: _____________________________________________________________

3. Consent to Participate

I, the undersigned parent or legal guardian, permit the above-named minor to attend and participate in AccessCon NYC 2026, taking place May 16 - 17, 2026, at the World Trade Center in New York, NY.

I understand that AccessCon is a professional youth leadership conference that includes keynote presentations, workshops, networking sessions, and related programming.

4. Assumption of Risk & Release

I understand that participation in the Conference involves inherent risks, including but not limited to personal injury, illness, travel-related risks, or property loss.

On behalf of myself and the minor participant, I voluntarily assume these risks.

To the fullest extent permitted by law, I release and hold harmless AccessCon, its organizers, affiliates, sponsors, partners, volunteers, and venue representatives from any claims, liabilities, damages, or expenses arising from participation in the Conference, except in cases of gross negligence or willful misconduct.

5. Medical Authorization

In the event of a medical emergency, I authorize AccessCon staff and event representatives to obtain emergency medical treatment for the minor participant if I cannot be reached immediately.

I understand that I am responsible for any medical expenses incurred.

Medical Conditions or Allergies (if any):

6. Code of Conduct Agreement

I acknowledge that AccessCon maintains behavioral and professional standards for all attendees.

I understand that if the minor participant engages in disruptive, unsafe, or unlawful behavior, AccessCon reserves the right to remove the participant from the event without refund or liability.

7. Photography & Media Release

I understand that photography and video recording will occur during AccessCon.

I grant permission for the minor participant’s image, likeness, and voice to be used in photographs, recordings, or promotional materials related to AccessCon without compensation.

If I do not consent to media use, I will notify AccessCon in writing before the event.

8. Acknowledgment

I certify that:

• I am the parent or legal guardian of the minor listed above.
• I have read and understand this Consent & Release Form.
• I agree to its terms voluntarily.

Parent / Legal Guardian Signature: ________________________________________________________

Printed Name: ________________________________________________________________________

Date: _______________________________________________________________________________