2026 Youth Summit Permissions Form

YOUTH SUMMIT PERMISSION FORM

This permission form is required for all attendees 22 and under
Try This WV is hosting a Youth Summit on Friday & Saturday, June 5th and 6th - and it's FREE for everyone!

The Youth Summit is developed by, and geared towards, WV youth ages 13-22. Some attendees are younger than 13 - that's okay! They just need a parent or guardian to chaperone them throughout the event.

This event is designed for youth to learn, share, and grow together on healthy community projects and leadership development. It is a space where young people are in charge and free to be themselves.

The Youth Summit will include plenty of networking opportunities, the chance to learn from different leaders across the state, delicious healthy food, physical activity exploration, and more, all at the request of young folks themselves!

This form must be completed by all youth participating in overnight activities, field trips, events requiring group transportation, and any other events hosted at WV Wesleyan College in Buckhannon, where it is deemed necessary by the event coordinator(s). The form should be submitted before the event.

If a youth participant is age 17 or younger, a parent or guardian must also view and sign this form, so we suggest filling it out together in one sitting.

Be sure to complete all sections and sign where requested!

Youth Participant Contact Information
Name:

First NameLast Name
Age as of June 4, 2026:
Date of Birth:

MonthDayYear
Date
Youth Participant's Preferred Pronouns:
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Please provide to following information for the parent or guardian completing this form
Parent/Guardian Full Name:

First NameLast Name
Parent/Guardian Email:
example@example.com
Parent/Guardian Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Information

Primary emergency contact
Emergency Contact Full Name:

First NameLast Name
Emergency Contact Primary Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Secondary Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email Address:
example@example.com
Emergency Contact Relationship to Attendee:
Will this emergency contact be on campus during the event?

YesNo

Health and Medical Information

This page is required for all youth ages 17 and under. For youth 18 and older, you may share what you are comfortable sharing!
Allergies (check all that apply):

No known allergiesFood Allergies (List Below)Medication Allergies (List Below)Other
Please list food allergies here:
Please list medication allergies here:
Please list other allergies here:
Do you have a medical condition we should be aware of?

NoYes
Please explain what we need to know about any medical conditions:

Permissions and Liability Wavers - Ages 18-22

All attendees ages 18-22 are required to fill out this section
General Liability Release
With the understanding the event coordinator(s) will use the utmost precaution in guarding the health of the above participant and preventing accidents, I release them from any liability in case of illness or injury as a result of this activity. Furthermore, I release the owner and the driver of the car transporting me to and from the event, from any liability in case of illness or injury.

I agree to this release
COVID-19 Acknowledgment
I understand that Try This WV and WV Wesleyan College cannot guarantee a COVID-free environment. By participating, I acknowledge the inherent risks and agree to follow any health & safety guidelines set by the event.

I accept these terms
Media Release
Try This WV may use event photos & videos for promotional materials (newsletters, brochures, etc.).

I allow my name & image to be usedI do NOT allow my name & image to be used and will avoid any group photos.

Permissions and Liability Wavers - Parents/Guardians of Youth Under 18
General Liability Release
I hereby give my youth participant permission to participate in the event listed. With the understanding the event coordinator(s) will use the utmost precaution in guarding the health of the above participant and preventing accidents, I release them from any liability in case of illness or injury as a result of this activity. Furthermore, I release the owner and the driver of the car transporting my child to and from the event, from any liability in case of illness or injury.

I agree to this release
I understand that Try This WV and WV Wesleyan College cannot guarantee a COVID-free environment. By participating, I/my youth participant acknowledge the inherent risks and agree to follow any health & safety guidelines set by the event.

I accept these terms
Media Release
Try This WV may use event photos & videos for promotional materials (newsletters, brochures, etc.).

I allow my/my youth’s name & image to be usedI do NOT allow my/my youth’s name & image to be used and will avoid any group photos.

Transportation Information
How will the participant travel to the event?

Driving themselves or carpooling with another participantA parent/guardian or trusted adult will transport them
How will the participant travel from the event?

Driving themselves or carpooling with another participantA parent/guardian or trusted adult will transport them
List anyone here who has permission to pick up this youth participant. Please note that we will require this person show their ID and sign out the young person before they are able to leave!
Who is authorized to pick-up and transport your youth participant from the event?

I authorize the person/people listed above to pick up my youth participantI authorize my youth participant's chaperone to sign them in/out and transport them to/from the eventI authorize my youth participant to self-checkout from the event and leave on their own
Drop off for the event will be on Friday, June 5, 2025, from 8:30-9:45 am

The drop off point will be at the fountain simicircle.

If you are parking, use the parking lot across the street from the fountain. There will be signs.

Pick-up/departure will be on Saturday, June 6, 2025, from 2:45-3:00 pm. Pick-up will be at the fountain circle.

If you need to make arrangements outside of these times, please contact us at trythiswv@gmail.com

Rules and Expectations

Please read the following closely before moving onto signatures!
WV Wesleyan College Youth Program Code of Conduct

The primary purpose of the Youth Program Code of Conduct is to ensure the safety and well-being of all participants at events and activities hosted at WV Wesleyan College in Buckhannon. It applies to all participants, including minors, their parents and guardians, and volunteers. As a participant in this program, I will:
- Conduct myself in a courteous manner and treat youth, parents and guardians, volunteers, staff, and others with respect. Appropriate language and behavior are expected at all times.
- Respect and adhere to the rules and guidelines of the program, including all those specific to this event or activity.
- Uphold an individual’s right to dignity by supporting an environment of inclusion that welcomes the involvement of participants from all backgrounds.
- Obey local, state, and federal laws.
Participants who fail to adhere to the Youth Program Code of Conduct are subject to a range of disciplinary actions from WV Wesleyan College staff. When appropriate, immediate corrective action will be taken at the event to ensure the safety and welfare of all participants. I understand that if I fail to adhere to the above Code of Conduct, I will be subject to disciplinary action and potentially prohibited from attending and participating in this event and future programs at WV Wesleyan College.

Try This will also enforce these rules and ensure a safe environment for everyone. In the case where a young person has been dismissed from the event but must wait for a ride home, they will be placed with a Try This volunteer chaperone for the remainder of their time at the event.
Try This Zero-Tolerance Policies

The Youth Summit is a sober, recovery-friendly space. There is a zero-tolerance policy for substance use while attending the Youth Summit. This means that participants should not come to these events under the influence of an illegal substance, use substances while engaged in Summit or distribute substances or paraphernalia to others. Failure to meet these expectations about substance use or possession during the Summit and Conference will result in immediate dismissal from the event. In the case where a young person has been dismissed from the event but must wait for a ride home, they will be placed with a volunteer chaperone for the remainder of their time at the event.

The Youth Summit is a space that respects privacy for all, especially young people. In order to best protect young people, we will not allow the use of “Smart Glasses” or any other device that can be used to record without the knowledge of others at the Try This WV Youth Summit. Use of unauthorized recording devices during the Summit will result in immediate dismissal from the event. In the case where a young person has been dismissed from the event but must wait for a ride home, they will be placed with a volunteer chaperone for the remainder of their time at the event. If you are using smart glasses as assistive technology, please contact us ahead of the event at trythiswv@gmail.com.

The Youth Summit is a tobacco, smoking, chewing, Zen pouch, and vaping-free space. Use of tobacco in any of these forms is not allowed. If you are an adult who uses tobacco, you must do so in your car or a designated smoking area, away from all young people. Underage smoking, chewing, and vaping during the Summit, or smoking, chewing, or vaping in a non-designated smoking area will result in immediate dismissal from the event. In the case where a young person has been dismissed from the event but must wait for a ride home, they will be placed with a volunteer chaperone for the remainder of their time at the event.
Youth Attendee Signature
By signing here I attest that I have read the Code of Conduct and the Zero Tolerance Policy and agree to abide by both:
Parent/Guardian Signature
By signing here I attest that I have read the Code of Conduct and the Zero Tolerance Policy and agree to abide by both:

Questions or Concerns?
We understand this is a lot of information - and you might have questions! Please reach out to trythiswv@gmail.com to speak to someone about the Youth Summit. We can't wait to see you there!
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YOUTH SUMMIT PERMISSION FORM

Youth Participant Contact Information

Parent/Guardian Information

Emergency Contact Information

Health and Medical Information

Medications and Permissions

Permissions and Liability Wavers - Ages 18-22

Permissions and Liability Wavers - Parents/Guardians of Youth Under 18

Transportation Information

Rules and Expectations

Questions or Concerns?

We understand this is a lot of information - and you might have questions! Please reach out to trythiswv@gmail.com to speak to someone about the Youth Summit. We can't wait to see you there!