The Lemon Aid Leadership Lounge Youth Leadership & Mentorship Program Parent Application

The Lemon Aid Leadership Lounge Youth Leadership & Mentorship Program Parent Application

Powered by The Lemon Aid Lounge LLC • Sip With A Purpose
Youth Information
Youth legal first name
Youth legal last name
Preferred name or nickname
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current age
Current grade level
School name
Youth gender
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City / State / ZIP code
Youth T-shirt size
Participated in another leadership, mentoring, sports, school, church, community, volunteer, or entrepreneurship program?
If yes, please briefly explain
Parent or Guardian Information
Parent or Guardian Full Name

First NameMiddle NameLast Name
Relationship to Youth
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Same as Youth Address
Preferred Contact Method
Best Time to Contact You

Hour Minutes

AM/PM Option
Second Parent or Guardian Full Name

First NameMiddle NameLast Name
Second Parent or Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Second Parent or Guardian Email
example@example.com
Emergency and Health Information
This information helps us support your youth safely. Do not request Social Security numbers or insurance numbers.
Emergency Contact Full Name

First NameMiddle NameLast Name
Emergency Contact Relationship to Youth
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does your youth have any food, environmental, medication, or other allergies?
Please describe the allergies and any needed precautions
Does your youth have a medical condition, physical limitation, disability, learning need, sensory need, or accommodation that program leaders should know about?
Please describe the condition, need, or accommodation
Does your youth take any medication that program leaders should be aware of during activities?
Please list the medication(s) and any important instructions. Program staff do not administer medication unless a separate written arrangement is approved.
Behavioral, emotional, communication, or social support strategies that help the youth succeed
Dietary restrictions
Emergency Medical Authorization
I authorize The Lemon Aid Lounge LLC program leaders to contact emergency services and obtain reasonable emergency care for my youth if I cannot be reached. I understand that I remain responsible for medical costs.
If No, please explain why emergency medical authorization is not granted
Youth Interests and Leadership Goals
Why is the youth interested in this program?
What are the youth’s greatest strengths?
What would you like the youth to gain from this program?

Other
Which activities interest the youth?
How comfortable is the youth speaking with new people?

1

2

3

4

1 is Not comfortable yet, 4 is Very comfortable
How comfortable is the youth working as part of a team?

1

2

3

4

1 is Not comfortable yet, 4 is Very comfortable
Does the youth need support participating in group activities?
Please share any additional information about the youth’s personality, interests, goals, or needs.
Availability and Parent Participation
Which days are generally best for your family?
Which times are generally best for your family?
Can a parent or guardian attend the required orientation before the youth’s first activity?
Can a parent or guardian remain onsite, reachable, and involved during required activities and events?
Do you understand that this is not a drop-off or childcare program?
Transportation plan
If other, please explain your transportation plan
List every adult who may be authorized to pick up or transport the youth
Are there any custody, pickup, or contact restrictions the program should know about?
Please provide confidential details about any custody, pickup, or contact restrictions
How much advance notice does your family usually need for activities?
Parent availability or scheduling notes
Participation Expectations
I understand that parent or guardian involvement is required at every level.
I understand that youth may not be dropped off unless a future activity is specifically approved in writing for a different arrangement.
I agree that my youth will follow safety, sanitation, event, and program instructions.
I agree that my youth will treat participants, families, mentors, customers, partners, and community members respectfully.
I understand that youth do not handle cash, complete public sales, receive wages, work independent shifts, or supervise other children.
I understand that participation benefits and recognition are noncash and may include free lemonade at program events, shirts, certificates, awards, and opportunities to shine.
I understand that The Lemon Aid Lounge LLC operates this program as a for-profit business and that it is not a nonprofit, charity, school, employment program, or childcare service.
I understand that submitting this application does not guarantee acceptance, placement, participation in every activity, or advancement to a leadership level.
I agree to notify program leadership promptly about absences, emergencies, health changes, or contact information changes.
I understand that serious or repeated unsafe, disrespectful, or disruptive behavior may result in removal from an activity or the program.
Photo, Video, and Media Permission
Media permission is optional and declining will not automatically disqualify the youth. No identifying posts will be made during an event. Only approved photos and release information may be used.
May The Lemon Aid Lounge LLC photograph or record the youth during supervised program activities?
If yes, where may approved images or video be used?
May the youth be interviewed or quoted about the program?
Parent media notes or restrictions
Parent Consents and Signatures
Accuracy Acknowledgment
Participation Permission
Parent or Guardian Electronic Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Youth Acknowledgment
Youth Typed Name
Should be Empty:

The Lemon Aid Leadership Lounge Youth Leadership & Mentorship Program Parent Application

Youth Information

Parent or Guardian Information

Emergency and Health Information

Youth Interests and Leadership Goals

Availability and Parent Participation

Participation Expectations

Photo, Video, and Media Permission

Parent Consents and Signatures