2026-27 HelpLine MC-YLC Parent Permission Form

HelpLine MC-YLC 2026-27 Parent PermissioN Form
HelpLine is excited to offer the Morrow County Youth-Led Council (MC-YLC) for a second year! Your student has expressed interest in learning more about MC-YLC.

Please complete the form to permit the HelpLine Prevention staff to contact your child with additional information.

Thank you for your support!

Questions?
Contact information will now be Brittany Wolf-Delawder, Youth Engagement Coordinator bwolfdelawder@helplinedelmor.org.
- Full Name of Student
  
  First NameMiddle NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Name
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Signature
- Parental Permissions
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Emergency Contact
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Emergency Contact Email
  example@example.com
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Please verify that you are human
- Should be Empty: