Release Forms

Parental Release Form

I am granting permission for the following persons to pick up my child from The Youth Development Program Workshops between November 2022 and May 2023

By identifying these individuals I hereby absolve The Youth Development Program of any legal responsibility once the child has been released to one of the designated individuals.

Full Name

Relationship to child

Child's Full Name

1. Full Name

1. Relationship to child

2. Full Name

2. Relationship to child

3. Full Name

3. Relationship to child

4. Full Name

4. Relationship to child

5. Full Name

5. Relationship to child

35765

Media Release Form

I hereby permit The PowerFilled Youth program to use my child’s photograph, visual likeness or voice in various displays, media and sales promoting its programs and participants.

Programs

Outreach Initiatives

Release Forms

Parental Release Form

Media Release Form

"Change will not come if we wait for some other person or if we wait for some other time. We are the ones we've been waiting for. We are the change that we seek." - Barack Obama

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