Coral Leisure Arklow Parental Consent Form For Teen Gym Users

Parental Consent Form For High Risk Runaway Child
Name of Teen

First NameLast Name
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Appointment
Pick One

In personZoom Call
I give consent to Hope Alive 845 to speak to my child regarding running away and allow them to give any resources that may help my child..

I also understand that all information is kept with Hope Alive 845.

I also understand i must be present when Hope Alive 845 speaks to my child.

I also Understand that Hope Alive 845 does NOT charge for their services but will accept a donation on my behalf.

I understand That Hope Alive 845 is not counselors but are advocates for the Youth.

I understand Hope Alive 845 will set up a zoom call or in person with myself and the child to speak to them on a regular once a week basis.

I understand that Hope Alive 845 will offer my child to particapate with other youths that are in their program.

If you wish to Make a Donation, Please visit our website www.Hopealive845.com
Parent/Guardian Signature

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