Parent Consent and Contact Information

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PARENTS, please fill out this form:

First and last name of Parent/Guardian*
Conference Agreement

I understand the themes that will be covered and presented to my daughter throughout the conference. I have reviewed the requirements that my daughter will be expected to fulfill as a participant of this conference and understand that if my daughter chooses not to fulfill the expectations and requirements as stated in this program guide, she may be removed from the conference. I agree to support my daughter in carrying out these responsibilities she has undertaken to participate:

  • Attending the summer conference with complete attendance
  • Take Action Challenge
    • Students must complete the TAC Plan document during the summer conference
    • Students must submit a 1-minute video presentation on their TAC at the end of their program participation
  • Mentorship
    • Students must initiate at least 2 meetings per semester with their designated mentor
  • Monthly Meetings - August-April
    • 100% attendance is mandatory
    • If absolutely necessary, students are allowed to miss up to 2 monthly meetings (taking place 5:30-7:00 pm, 1st Wednesday of each month, excluding January)

I hereby give The Pangea Network’s Young Women’s Leadership Challenge permission to use any still and/or moving image, including video footage, photographs, and/or frames, and/or audio footage depicting my daughter and her name to be published on The Pangea Network’s internet site in advertisements, marketing, leaflets, or any other use such as for training, educational, or publicity purposes. I also understand that The Pangea Network only uses such material in an appropriate and responsible manner.

I hereby waive, release, and forever discharge The Pangea Network, their directors, affiliates, partners, officers, agents, servants, contractors, employees, representatives, and volunteers, and their respective successors, assigns, heirs, and personal representatives from and against any and all claims, costs, liabilities, damages, obligations, expenses, losses, or judgments, including reasonable attorney fees and court costs arising out of or by reason of any activities relating to the Young Women’s Leadership Challenge (YWLC) Activities or My Child’s participation in the YWLC Activities.

I further hereby agree to indemnify, defend, and hold harmless The Pangea Network and each Indemnified Party from and against any and all such claims by third parties arising out of or by reason of any activities relating to the YWLC Activities or My Child’s participation in the YWLC Activities.

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