ELEVATE Youth Prevention Summit Permission Form 2024

Permission Form & Media Release

ELEVATE Youth Prevention Summit
This event is being held by Prevent Coalition and is a training for youth ages 12-18 who are interested in learning more about how to do prevention work in their communities.

This event is an in person event being held at The Water Resource Center.

Training Objectives include:
- Created a space to form meaningful connections with other caring youth
- Felt empowered as an agent of change and a leader in their community
- Engaged in a variety of activities and content relevant to prevention, wellness, and youth leadership.
Youth/Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Do you have any food allergies, sensitivities, or restrictions?
I give permission for (Youth/Student named above) to attend the Elevate Youth Summit sponsored by the Prevent Coalition. I acknowledge this event is held in person at The Water Resource Center on April 25, 2025 9:30 am - 2:30 pm.*

Yes, I give permission.No, I do not give permission.
I give permission for (Youth/Student named above) picture to be taken and used by the Prevent Coalition)*

Yes, I give permission.No, I do not give permission.
Signature

Clear
For questions or concerns contact Prevent Coalition at preventcoalition@esd112.org or visit www.preventcoalition.org
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Permission Form & Media Release