Virtual Teen/Tween Consent Form
This form will provide proof of permission from parents/guardians for Teen and Tween group Zoom calls.

All calls are monitored by at least one trained CHIPS staff.

Teen Center Zoom Protocol:
All youth and staff on Teen Center calls must follow the guidelines below. 

Youth and staff must dress as they would at the Teen CenterYouth/staff should join a video chat  from an appropriate space in the home (such as at a kitchen table, desk, common space, the outdoors etc., not laying/sitting on their bed or walking around with the computer or phone in their hands.

Youth/staff should refrain from "showing each other around their house"  by walking around and showing the interior of their home. This can be uncomfortable for parents or others in the home that don't want to participate in the call.

 Youth are expected to behave appropriately when video chatting much like they would in the Teen Center. 

If you have any questions please email
Do you give permission for your youth to participate in the Teen/Tween Center calls? *
Youth name *
Grade level *
Parent name *
Parent email *
Parent phone number *
Do you have any questions or ways we can support you or your youth?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Essex CHIPS, Inc..