Parental Consent Form

Parental Consent Form

“Build Skills. Lead Strong. Shape Tomorrow.”
Purpose: This form grants parental or legal guardian consent for youth to participate in Next Path Alliance programs, including mentorship, workshops, activities, and events. The safety and well-being of each participant is our top priority.

Please complete the form in full.
Participant Information:
Youth's Full Name:

First NameLast Name
Date of Birth:

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-Shirt Size:

Youth SYouth MYouth LAdult SAdult MAdult L
Parent/Guardian Information:
Full Name:

First NameLast Name
Relationship to Youth:
Phone Number:
Please enter a valid phone number.
E-mail Address:
example@example.com
Preferred Contact Method:

PhoneEmailText
Program Participation:
I give permission for my child to participate in the following Next Path Alliance programs:

Mentorship & Leadership DevelopmentCareer & College ReadinessPersonal Growth & Life SkillsSports ProgramCommunity Events & Volunteer ProjectsEntrepreneurship & Innovation Hub
Health & Emergency Information:
Does the participant have any allergies?

YesNo
If yes, please list:
Does the participant have any medical conditions or injuries we should be aware of?

YesNo
If yes, please list:
Is the participant currently taking any medication?

YesNo
If yes, please list:
Primary Physician’s Name:

First NameLast Name
Primary Physician’s Phone Number:
Please enter a valid phone number.
Health Insurance Provider:
Emergency Contact:
Full Name:

First NameLast Name
Relationship to Youth:
Phone Number:
Please enter a valid phone number.
Media Consent:
I give permission for my child's photo/video to be taken and used for marketing and promotional purposes.I do NOT give permission for my child's photo/video to be taken.
Code of Conduct Agreement:

I acknowledge that my child must abide by the NextPath Alliance Code of Conduct, treating others with respect, participatin gsafely, and upholding community values.
Liability Waiver:

I understand that while safety measures are in place, participation in any program involves some risk. I hereby release and hold harmless Next Path Alliance and its staff, volunteers, and partners from any liability or claims arising from my child’s participation.
Agreement & Signature:
Printed Name:
Signature:

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Thank youfor trusting Next Path Alliance with your child’s growth and development. We are committed to empowering youth and fostering safe, inspiring experiences.
Should be Empty:

Parental Consent Form

Purpose: This form grants parental or legal guardian consent for youth to participate in Next Path Alliance programs, including mentorship, workshops, activities, and events. The safety and well-being of each participant is our top priority.

Participant Information:

Parent/Guardian Information:

Program Participation:

Health & Emergency Information:

Emergency Contact:

Media Consent:

Code of Conduct Agreement:

Liability Waiver:

Agreement & Signature:

Thank youfor trusting Next Path Alliance with your child’s growth and development. We are committed to empowering youth and fostering safe, inspiring experiences.