Culinary Academy Teen Application

Parent/Guardian/Caregiver Information
Primary Parent/Guardian Name:*
Relationship to the child:*
Cell Phone Number:*
Please enter a valid phone number.
Home Phone Number:
Please enter a valid phone number.
Address if different from child:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Email Address:*
example@example.com
Total number of adults and children currently residing in your home:*
Household Income (annually)*
Emergency Contact #1
Emergency Contact Name:*
Emergency Contact Relationship to Child:*
Emergency Contact Cell Phone Number*
Please enter a valid phone number.
Emergency Contact Home Phone Number
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Emergency Contact #2
Emergency Contact Name:
Emergency Contact Relationship to Child:
Emergency Contact Cell Phone Number
Please enter a valid phone number.
Emergency Contact Home Phone Number
Please enter a valid phone number.
Emergency Contact Email
example@example.com

In the interest of Type a label* (Student Name),
Permission
This gives my permission for the above-mentioned child to be involved in the Next Gen Chefs Program at Youth Guidance.
Transportation
Permission is also given to Youth Guidance to transport my child to and from school on Mondays and Wednesdays if they attend Sebastian River High School.
Liability
I release Youth Guidance, its staff, and its volunteers for any liability of lost, stolen, and/or damaged items that may occur while my child participates in Next Gen Chefs Program or personal activity with volunteer(s) and employees. If my child needs any emergency medical treatment while in the care of Youth Guidance, this is my authorization for such treatment (if I cannot be reached). This is also my authorization to the attending physician and emergency care facility. I assume the expense of any medical care.
Medical
I give permission for Youth Guidance and its employees to seek medical treatment for my child if they are unable to reach any parent or guardian. I also agree that I will be responsible for any financial debt that is accumulated by said action.

This is also the authorization of the child and parent/guardian for you to provide Youth Guidance full particulars regarding the child's mental and/or psychological and psychiatric history and any other pertinent information requested.
Further, this authorizes all agencies involved with the child to release all information to Youth Guidance.
I have read the foregoing and fully understand the meaning and effect thereof.

Photo/Video Release
Please enter your child's name:*

First NameLast Name
I hereby consent to the reproduction, publication and use of photographs/video footage taken of my child...I hereby DO NOT consent to the reproduction, publication and use of photographs/video footage taken of my child...
by Youth Guidance and other groups involved with Youth Guidance for advertising, sponsorship, educational and/or publicity purposes in all publications, Websites, television, social media, advertisements and publicity materials, without limitations or reservation, as deemed appropriate by the organization.

I also consent to any testimony or text written about the person named above that may accompany said photographs or stand-alone in all publications, advertisements and publicity materials, without limitation or reservation, as deemed appropriate by the organization. I understand that I will receive no remuneration due to my child's photo.

I agree that I will not assert or maintain against Youth Guidance and other groups involved with Youth Guidance, their successors, assigns and licensees, any claim, action, suit or demand of any kind or nature whatsoever, including but not limited to, those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any other reason in connection with the authorized use of my physical likeness and sound in the picture as herein provided.

I hereby release Youth Guidance and other groups involved with Youth Guidance, their successors, assigns and licensees, and each of them, from and against any and all claims, liabilities, demands, actions, causes of action(s), costs and expenses whatsoever, at law or in equity, known or unknown, anticipated or unanticipated, which I ever had, now have, or may, shall or hereafter have by reason, matter, cause or thing arising out of the use of any images as herein provided.
I have read the foregoing and fully understand the meaning and effect thereof.
Parent/Guardian Name*

Attendance Policy
For Youth Guidance to provide high quality programs and build positive relationships, our students and families must also dedicate their time and effort towards our program.

Students will be allowed three (3) excused absences before being taken out of the program for the remainder of the current semester. The number of tallied excused absences will start over at the beginning of each new semester.

Contact must be made between Youth Guidance Staff and the Parent/Guardian prior to or on the day of the absence at least three (3) hours prior to the start of the program.

Lack of following this attendance policy will result in your child being removed from the current program and placed on the waitlist or given last priority upon enrolling in future semesters.

The following constitutes excused absences:
1. Medical/Illness or Injury
2. Death in the Family
3. Religious Observances
4. Family Vacation
5. School Function
I have read and understand the above attendance policy for Youth Guidance and agree to its terms and conditions.
Parent/Guardian Name*

Student Admission Policy
Youth Guidance Next Gen Chefs is an after-school program that provides Career Development, Life Skills, and Vocational Training for students who reside in OR attend school in Indian River County.

For your child to participate and maintain their scholarship in the Youth Guidance Next Gen Chefs Program, the following criteria requirements must be met by the student:

The STUDENT will/does:
- Qualify for free or reduced lunch.
- Reside in or attend public, charter, private or homeschool in Indian River County.
- Attend and participate in the program.
- Adhere to the program expectations set by the Youth Guidance Staff on and off-site.
- Adhere to the 3-Strike Policy and maintain reasonable behavior by being honest and respectful to staff members, volunteers, mentors, peers, and community partners while participating in Youth Guidance Programs.
- Behaviors that are grounds for immediate removal from the program include (but are not limited to):
  - Fighting
  - Disrespecting Staff
  - Obscene gestures
  - Stealing Vandalism/destruction of property
  - Inappropriate touching
  - Bullying
  - Illegal activity (ex: drug or alcohol use, possession of weapons)
- Dress in a manner that allows full participation in the program. Clothing that is prohibited includes:
  - Clothing/jewelry that displays logos or images that promote drug use, alcohol, violence, or racism.
  - Open toed shoes (ex: crocs, sandals, or slides
  - Clothing that exposes the midriff or other parts of the body (ex: crop tops, spaghetti straps, booty shorts, see-through apparel, skintight clothing, etc.)
- Adhere to the Youth Guidance cellphone/electronics policy.
  - Students can use their cell phones during the time frame given by Youth Guidance program staff.
  - Additionally, staff may permit phone use at other times for Educational or Emergency purposes.
I have read and understood the above admissions policy for the Youth Guidance and agree to its terms and conditions.
Student Name:*
Parent Name:*

Parental Acknowledgement Form
For Youth Guidance to provide high quality programs and build positive relationships, our students and families must also dedicate their time and effort towards our program.

Students will be allowed three (3) excused absences before being taken out of the program for the remainder of the current semester. The number of tallied excused absences will start over at the beginning of each new semester.

Contact must be made between Youth Guidance Staff and the Parent/Guardian prior to or on the day of the absence at least three (3) hours prior to the start of the program.

Lack of following this attendance policy will result in your child being removed from the current program and placed on the waitlist or given last priority upon enrolling in future semesters.

The following constitutes excused absences:
1. Medical/Illness or Injury
2. Death in the Family
3. Religious Observances
4. Family Vacation
5. School Function
I have received and read the Youth Guidance application. I understand that failure to follow any of the outlined policies and procedures could result in my child’s removal from the program. I fully understand and agree to all conditions stated on the application form. I have counseled my child to conform to the rules and the authority of the employees of Youth Guidance. I understand that my child’s scholarship in Youth Guidance programs may be suspended or canceled at any time. Actual consequences are determined on a case-by-case basis and are at the discretion of the Executive Director or Director of Operations.
Parent/Guardian Name*
Parent/Guardian Signature*

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Culinary Academy Teen Application

Parent/Guardian/Caregiver Information

Emergency Contact #1

Emergency Contact #2

Permission

Transportation

Liability

Medical

Photo/Video Release

Attendance Policy

Student Admission Policy

Parental Acknowledgement Form