Parent Consent Form for The P.A.T.H. Program

Parent Consent Form for The P.A.T.H. Program

Please complete this form to register your teen for the P.A.T.H. Program. Registration deadline is 06/15/2026.
Participant Information
Participant's Full Name

First NameLast Name
Participant's Date of Birth

MonthDayYear
Date
Participant's Age
Please note that the child should fall between 14-17 years old to be eligible.
How did you hear about us?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the participant receive Medicaid?
Parent/Guardian Information
Parent/Guardian Full Name

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

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is this person authorized to pick up the child?
Eligibility Requirements:
- Must be a resident of New Albany, Gahanna, or Westerville.
- If you are not a resident, you must be willing to travel to the workshop location in Gahanna or New Albany.
- Age Restriction: 14 to 17 years old.
- Students must have a work permit before applying (completed except for the employer information).
- Willing and able to work this summer.
- Parental approval is required after academic review and schedule alignment.
- Medicaid applicants must be evaluated by a Licensed Therapist in order to qualify for services. A parent must be present during this time.
- Provide proof of identity, which may include: Birth certificate and/or Social Security card. Photo ID (state-issued or school-issued).
- I understand that failing to meet the eligibility requirements may disqualify students participation in the P.A.T.H. Program.
By checking the box below, you have read and agree to the terms and hereby give my child consent to participate in Straight Path Coaching's P.A.T.H. Program.
Please type in your name below to consent to the terms and agreement.
Date

MonthDayYear
Date
Should be Empty:

Parent Consent Form for The P.A.T.H. Program

Participant Information

Parent/Guardian Information