2025-26 HelpLine DC-YLC Parent Permission Form

Parent/Guardian Information
Name*

First NameLast Name
Relationship*
ex. Father, Mother, etc.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Signature*

Clear
Parental Permissions*

I give permission for my student to receive updates about the 2025-26 HelpLine Delaware County Youth-Led Council (DC-YLC) and its associated events.I give permission for my student to apply and participate if selected in the 2025-26 HelpLine Delaware County Youth-Led Council (DC-YLC) and its associated events.I give permission to HelpLine to use photos, video footage taken during DC-YLC activities for the general purposes of social media, websites, newsletters or brochures to promote the council.I give permission for medical attention to be sought in the case of an emergency. I will also expect to be notified of any medical situation that may arise.Please contact me with more information.
Date*

MonthDayYear
Date