Student Consent and Contact Information

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STUDENTS, please fill out this form:

First and last name of Parent/Guardian*
Program Requirements Agreement

I understand the information that will be covered and presented to me throughout the program. I understand that everything shared by participants during the program is completely confidential, and I understand that if I choose to discuss anything shared by other participants, this is grounds for immediate expulsion from the program. Confidentiality is of utmost importance in this organization.

I have reviewed the requirements that will be expected of me to fulfill the expectations and requirements as stated in this program guide, and I understand that I may be removed from the program. These requirements include:

  • 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)

With my signature, I understand that I am required to attend the YWLC summer conference and monthly meetings starting in August 2025 through April 2026, along with a minimum commitment of 25 service hours within one year.

Name*
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