Peer Ambassador Parent/Guardian Form

HYPE Peer Ambassador Parent/Guardian Form

Thank you for supporting your student’s participation in the HYPE Leadership Council! As a Peer Ambassador, your student will have opportunities to develop leadership and communication skills while participating in educational presentations, community outreach, and other program activities. Please review the information below and complete the Parent/Guardian Consent and Media Release Form. Your signature confirms that you have reviewed the information and give permission for your student to participate

Student Full Name

School

Student Email

Please use the email address the student used on their Peer Ambassador application.

Parent/Guardian Name

Parent/Guardian Email

Emergency Contact Phone

Parent/Guardian Consent

I give permission for my child to participate in the HYPE Leadership Council, a youth leadership program coordinated by The Bridge Center for Health Education. I understand that my child may participate in

leadership training, educational presentations, planning meetings, community outreach activities, and other program-related events throughout the school year. I understand that The Bridge Center for Health Education will provide the necessary training, materials, and supervision for all program activities.

I acknowledge that participation in the HYPE Leadership Council is voluntary and that my child is expected to represent their school and The Bridge Center in a respectful, responsible, and professional manner. I understand that failure to meet program expectations or school policies may result in removal from the program.

I understand that I will be notified of any activities requiring transportation, travel outside the school campus, or additional parental permission.

By signing below, I acknowledge that I have read and understand this consent form and grant permission for my child to participate in the HYPE Leadership Council.

Media Release

I authorize The Bridge Center for Health Education (The Bridge Center), acting for and on behalf of its Board of Directors and those acting pursuant to its authority, to:

(i) record my child's likeness and/or voice on video, audio, photographic, digital, electronic, or any other medium;

(ii) use my child's name and biographical material in connection with such recordings; and

(iii) use, reproduce, exhibit, and/or distribute my child's first name, biographical material, and such recordings in any medium, including print publications, video, internet, and The Bridge Center's website, for promotional, educational, and/or other lawful purposes.

I agree to release The Bridge Center from all liability related to the photos or recordings and waive any claims or rights of compensation or ownership regarding such uses. I understand and agree that all such recordings shall remain the property of The Bridge Center.

By signing below, I acknowledge that I have read and understand the Parent/Guardian Consent and Media Release above. I give permission for my child to participate in the HYPE Leadership Council and authorize the use of my child's name, likeness, voice, photographs, video, and other recordings as described in the Media Release.

Parent/ Guardian Signature

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