Teen Huddle Application 2024-2025
Please complete and submit the form. If you meet the requirements, you will be contacted for an interview. Any questions please email Contact@hopeforthree.org
About You
Full Name
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First Name
Last Name
Contact Number
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Please enter a valid phone number.
Email Address
*
example@example.com
Preferred Method of Contact
*
Text
Phone call
Email
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthday (Must be 15 years-old by September 1, 2024)
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Please select a month
January
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Please select a year
2024
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Year
Age
*
Gender
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Male
Female
I prefer not to answer
List any languages you speak fluently:
How did you learn about Teen Huddle?
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Would you be interested in a leadership role?
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Yes
No
School Information
Name of School attending during 2024-2025 School Year
*
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School District
*
What grade are you entering during the 2024-2025 School Year?
*
Principal, Counselor or PALs Teacher Name
Parent(s)/ Legal Guardian(s) Information
Guardian 1 Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Guardian 2 Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please provide address for guardian 2 if different from student's address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Short Response Questions
What aspects of Teen Huddle appeal to you most, and why?
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Describe your experience, if any, working with children with special needs, or children with autism spectrum disorder.
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What volunteer contributions can teens offer that are different from those adults provide?
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What challenges do you foresee working with children who have siblings with autism and what will you do to overcome these challenges?
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What extracurricular activities are you currently involved in? Will the time commitment required for your extracurricular activities and the time required for Teen Huddle conflict? If not, why?
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What are your hobbies?
Have you ever participated in any leadership activities?
Please list all your extracurricular activities for 2024-2025
*
2024-2025 Hope For Three Teen Huddle Contract
2024 - 2025 H43 Teen Huddle Contract Please mark each statement. All Teen Huddle sessions and events will take place on the weekends, either Saturday or Sunday, every month.
I commit to attend the Saturday monthly sessions of the 2024-2025 Teen Huddle program.
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Yes
No
I understand my commitment to Teen Huddle includes attendance at the following special events in addition to the monthly Teen Huddle activities: 1. August: Retreat/ Orientation (overnight Galveston Retreat) 2. April: Car Wash For Kids - Sunday 3. April: Family Fun Fest - Saturday 4. May: Teen Huddle Banquet - Sunday
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Yes
No
Teen Huddle membership requires participation in all sessions and components. This includes, but is not limited to volunteer projects, discussions, etc.
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Yes
No
Failure to attend three regularly scheduled and special events can negatively impact future participation in Teen Huddle. This determination will be made by the Teen Huddle adults: Volunteer, Chair and Co-Chair.
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Yes
No
I understand transportation to and from the Teen Huddle session(s) is the responsibility of the parents/legal guardians and/or the Teen Huddle applicant.
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Yes
No
It is my responsibility to positively represent and promote H43 and Teen Huddle. This includes, but is not limited to Facebook, Instagram, Messenger, and other forms of social media.
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Yes
No
Any communication from Teen Huddle requires a response within 24 hours. Responses via email, text, and/or phone is acceptable.
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Yes
No
Signature - I have read and accepted the contract conditions listed above.
*
Back
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Parent(s) /Legal Guardian(s) Release / Consent to Participate
Parents/Legal Guardians Release/Consent to Participate Please sign after reading the statement
I hereby grant permission for my son/daughter to apply to the 2024-2025 Teen Huddle, I recognize the time commitment required to fully participate and agree to meet the criteria outlined by the Teen Huddle.I understand that transportation to and from the Teen Huddle session(s) is the responsibility of the parents/legal guardians and/or the Teen Huddle applicant.By signing below, I hereby release and hold harmless Hope for Three Autism Advocates, Teen Huddle, and the volunteers participating in the program from and against any injury, loss, damage, accident, or expense arising out of, or in any way related to, participation in the 2024-2025 Teen Huddle activities.I acknowledge and have carefully read this release and understand its impact and effect. acknowledge if I have any questions regarding this release, I have exercised my right to have it reviewed and further explained to me prior to signing.
Parent Signature
*
Email
example@example.com
Date
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Month
-
Day
Year
Date
Parents/Legal Guardians Medical Release
Parents/Legal Guardians Medical Release Please sign after reading the statement.
I hereby give permission to the Teen Huddle and its designated Teen Huddle volunteers, and any other trained medical personnel to treat my child in a situation that requires medical attention. I authorize said volunteers to seek such medical advice, treatment, and services as they deem necessary, in their sole discretion, which may be necessitated because of any injury or illness suffered because of my child’s participation in the activities of the Teen Huddle.I further agree to accept any financial responsibility for the care and treatment of such injuries or illnesses and for such further medical services which are required, even though all attempts to contact responsible parties have failed and there is urgency with respect to my child’s treatment, or in the case in which benefits of my health insurance have been depleted and additional medical expenses or loss of income occur.I understand that any medication my child may need for severe allergies (including bee stings, food allergies), asthma or other such medical condition(s) must be brought with my child to the programI have read the foregoing document in its entirety, fully understand the same, and freely and voluntarily sign my name to the medical release.
Signature
*
Date
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Month
-
Day
Year
Date
Parents/Legal Guardians and Student Photography/Communications Release
Parents/Legal Guardians and Student Photography/Communications Release Please sign after reading each statement
I hereby authorize the Teen Huddle to publish the photographs or video taken of my child, and their name, for use in printed publications, videos, and on authorized websites.I acknowledge that since my son/daughter’s participation in media produced by the Teen Huddle is voluntary, we will receive no financial compensation.I further agree that my son/daughter’s participation in any media produced by the Teen Huddle confers no rights of ownership whatsoever to my child or me. I release the Teen Huddle from liability for any claims by me or any third party in connection with their participation.
Parent Signature
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Student Signature
*
Date
-
Month
-
Day
Year
Date
Submit
Submit
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