2025 National Rural Electric Cooperative Association's Electric Cooperative Youth Tour Health Forms

2025 Electric Cooperative Youth Tour Health Form
We're excited to have you joining us in Washington, D.C. for the 2025 Electric Cooperative Youth Tour sponosored by the National Rural Electric Cooperative Association and America's Electric Cooperatives.

If this Form is being submitted for a high school Youth Tour Delegate who has not reached the age of majority in his/her respective state, this form must be completed and signed by a parent or legal guardian of the minor high school Youth Tour Delegate.
- Youth Tour Delegates and their parents / guardians must read the health form and attest the information given is true and complete.
- Information cannot be saved and revisited later so please plan to complete the form together.
- Please contact YouthPrograms@NRECA.coop or your state's Youth Tour Director with any questions.
Privacy Notice: Your privacy is important to us. NRECA will only collect, use, distribute, or share the information collected in this 2024 NRECA Youth Tour Health Form (Form) for planning and initiating health protocols and providing appropriate medical care, as necessary for your health and safety as a Youth Tour participant. NRECA will not, and will not authorize any third party to, sell, lease, license, distribute, share, or otherwise use the information collected in this Form for any other purpose. NRECA and its affiliated co-ops and statewide associations may use the contact information collected during your youth tour participation to inform you about future opportunities sponsored by them. NRECA will not sell, distribute, use, or share your information collected in this form or any other with any third party; or use, share, sell, or distribute your information for any purpose other than to inform you about their sponsored opportunities. To update or delete your information post-event, please email YouthPrograms@NRECA.coop. Please be as honest and thorough as possible.

Participant Information

Please be as honest and thorough as possible. This information is not intended to limit participation in the program.
The following form is being completed for a*

Youth Tour DelegateYouth Tour Director, Chaperone or other Staff MemberNRECA Staff

	Please list any relevant information here
Medication Name
Dosing Schedule
Does the participant require assistance?
Storage Instructions
Additional Comments

	Please list any relevant information for medication #2 here
Medication Name
Dosing Schedule
Does the participant require assistance?
Storage Instructions
Additional Comments

	Please list any relevant information for medication #3 here
Medication Name
Dosing Schedule
Does the participant require assistance?
Storage Instructions
Additional Comments

	Please list any relevant information for medication #4 here
Medication Name
Dosing Schedule
Does the participant require assistance?
Storage Instructions
Additional Comments

	Please list any relevant information for medication #5 here
Medication Name
Dosing Schedule
Does the participant require assistance?
Storage Instructions
Additional Comments

Acknowledgments

Please complete all required fields below.
If the circumstances of the Youth Tour participant identified in this Form changes between the submission of this Form and Youth Tour, you must notify your state’s Youth Tour Director regarding the change in circumstance as soon as possible, but no later than three (3) days prior to the start of Youth Tour.*

If the circumstances of the Youth Tour participant identified in this Form changes, I will notify my state’s Youth Tour Director regarding the change in circumstance as soon as possible, but no later than three (3) days prior to the start of Youth Tour.
Parent/Legal Guardian of Youth Tour Delegates and Staff, PLEASE READ, check each box, complete the information below, and Sign:*

I attest the information above to be true and complete to the best of my knowledge.I authorize NRECA and the statewide associations to use the information collected in this Form to provide care to me while attending the Youth Tour event as well as to develop appropriate safety protocols for the program.I further authorize NRECA and the statewide associations to share information collected in this Form with Youth Tour chaperones, directors and nurses who have a need to know for the purpose of providing care to the Youth Tour participant identified in this Form.I understand that to participate in Youth Tour, I must comply with all mandates and policies extended by NRECA, state and local governments, my statewide association, the venues, federal buildings, hotels, transportation systems, etc. involved in my Youth Tour experience, from the time I leave my home until I return.I will also willingly and truthfully submit information regarding other changes that may have occurred regarding my health and participation status, including illnesses or injuries.I understand that failure to adhere to any requirements or rules, including those listed here as well as those outlined or implied by NRECA staff, or staff of my statewide association, local electric cooperative, venues, public spaces, etc. will be viewed as noncompliance and I will be subject to removal from the program and returned home, at my family's expense, prior to the program completion.I authorize NRECA and the statewide associations to use the information collected in this Form to contact me/my minor child about future Youth Program opportunities, if applicable.
Signature*

Clear
Name*

First NameLast Name
Relationship to Youth Tour participant *
Date*

MonthDayYear
Date
Should be Empty:

	Name	Phone Number	Email	Relationship to Youth Tour participant
Guardian 1
Guardian 2
Guardian 3
Guardian 4

2025 Electric Cooperative Youth Tour Health Form

Participant Information

Participant Information

Acknowledgments