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Breakout Youth Mental Health Summit
Parent/Guardian Consent Form
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Event Overview
The Breakout Youth Mental Health Summit is a two-day event designed to provide students with exposure to important topics surrounding youth mental health, access to local services, and opportunities to engage with mental health professionals, industry experts, and persons with lived experiences.
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Event Details
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Dates
October 13,14 & 15, 2026
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Dress Code
School gym uniform
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Meals
Lunch and snacks provided
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Program Information
Students will participate in sessions covering mental health, wellness, and resilience. Sessions may include sensitive discussions about lived experiences. Parents/guardians are encouraged to review session options with their child prior to selection. Some workshops may require additional waivers or consents, which will be provided in advance. Qualified mental health professionals will be onsite to provide support if needed.
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Confidentiality & Disclosures
Discussions are intended to be safe and supportive; however, confidentiality cannot be guaranteed in group settings. Any disclosures of harm to self, harm to others, or abuse will be handled by trained professionals and reported in accordance with Bermuda’s child protection and safeguarding laws.
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Supervision & Safety
Students will be supervised by event staff, volunteers, and qualified professionals at all times. Emergency medical support will be available onsite. In the event of illness or injury, first aid will be administered and emergency services contacted if required.
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Personal Information Protection (PIPA)
Personal information collected on this form and throughout the event will only be used for:
- Confirming participation
- Ensuring health, safety, and dietary needs are met
- Following up with parents/guardians regarding incidents, consents, or next steps
Information will be stored securely, accessed only by authorized personnel, and not shared with third parties without consent unless required by law.
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Photo, Video, and Media Release for {q2_fullname0}
During the Summit, photos, video, and audio recordings may be taken for documentation, promotional, and educational purposes. Materials may appear in print, social media, press releases, websites, and other media associated with the Summit or its partners. No personal information (such as student names) will be shared publicly without additional written consent. Parents/guardians may withdraw consent at any time by notifying the organizers in writing; this will not apply retroactively to materials already published. Audio will only be available for interviews; all other recording will be video only.
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Consent & Acknowledgement
By signing below, I acknowledge and consent to the following:
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My child, [Insert Student’s Full Name], has my permission to attend and participate in the Breakout Youth Mental Health Summit. |
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I understand that my child may be exposed to sensitive topics related to mental health and wellness. |
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I consent to my child receiving immediate medical attention in the event of illness or emergency, including first aid and/or hospital treatment if necessary. |
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I understand that mental health professionals will be onsite and that my child may access support services during the Summit. |
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I understand that additional waivers/consents may be required for certain workshops and agree to review and sign them as necessary. |
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I release the organizers, sponsors, staff, and volunteers of the Summit from liability for accidents, injuries, or incidents during participation, except in cases of gross negligence. |
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I have reviewed the session information with my child and understand the nature of the topics being discussed. |
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