Youth Heal & Organize in YCOSAE
YCOSAE is Youth Community Organizing & Social Action for Equity!

Young people ages 14 to 21 are invited to participate. Complete and submit the application to participate. The application takes less than 5 minutes to complete.

YCOSAE directed by Good Journey and TEACH organizations, works to help young people become change making community leaders who use self-care to deal with the stress and challenges they face.

We will meet every week in the community doing fun and interesting activities, some fieldtrips, guest speakers and more...

Contact Dionne at 314-229-9079 or dionne.ferguson@goodjourney.org OR Steve at 314-243-2574 or obasi77@yahoo.com for more information.
Email *
YCOSAE & Lead Organizations
TEACH and Good Journey have a passion for working with young people and helping them develop into the beautiful people they are intended to be, so that they can positively contribute to our community and world. We know that our young people deserve to live in a better world. We also know that for that world to exist, our young people will have to help create it. YCOSAE was created to assist our young people with the development of skills needed to become community mobilizers. As community mobilizers, we want young people to understand and take responsibility for their role in building community, to gain a better sense of themselves and their purpose, and gain pride for the the community and world they can affect through their actions. Your young person will meet in a group of approximately 15 youth with adult leaders and mentors of YCOSAE, once every week.
PLEASE TYPE IN YOUR NAME BELOW AS THE LEGAL PARENT/GUARDIAN PROVIDING CONSENT AS SET OUT ABOVE AND BELOW TO INVOLVE YOUR YOUNG PERSON(S) AS A PART OF THE YCOSAE PROGRAM AND ACTIVITIES: *
CUSTOMARY MEETING LOCATION:
TBD (location will be convenient for youth)
BEGINNING AND ENDING DATES:
YCOSAE will begin meeting immediately, and continue through August 2021.
DAYS OF WEEK:
Thursdays and other program dates as scheduled
PLANS FOR MEALS:
Dinner provided
TRANSPORTATION:
Regular transportation used by student(s) as approved by parents/guardians or special transportation authorized by Good Journey Development Foundation and partners as scheduled.
PLEASE COMPLETE THE FOLLOWING INFORMATION REQUESTED BELOW:
Youth's full name: *
Youth's age: *
2nd Youth's full name:
2nd Youth's age:
Clear selection
3rd Youth's full name:
3rd Youth's age:
Clear selection
Youth's address - include zip code: *
Parent/Guardian address (if different from youth's address) - include zip code:
Parent/Guardian home number: *
Parent/Guardian cell number: *
Parent/Guardian work number:
Student's cell number:
Parent/Guardian email address:
2nd Parent/Guardian name:
2nd Parent/Guardian address, if different from youth's address - include zip code:
2nd Parent/Guardian home number:
2nd Parent/Guardian cell number:
2nd Parent/Guardian work number:
2nd Parent/Guardian email address:
1. I have been informed of the details related to the transportation of my student(s), and my student has my permission to be transported in the manner described above.
2. I understand that my student(s) will be under supervision by personnel working under the auspices of Good Journey Development Foundation and I agree to instruct my youth(s) to obey all rules, regulations and instructions given by staff, volunteers and/or mentors authorized by Good Journey. I further agree that no authorized personnel shall be held liable for any harm incurred to or by my youth(s) as a result of my student(s)'s deliberate, disobedience of rules, regulations or instructions.
3. The authorized personnel, volunteers and mentors under the auspices of Good Journey will supervise your youth(s) during YCOSAE program sessions, and neither they, nor Good Journey, nor any collaborating organization shall be liable, absent gross negligence on their part.
YOUR SIGNATURE AND DATE (TYPE NAME AND TODAY'S DATE) BELOW INDICATES THAT YOU HAVE READ AND AGREED TO THE AFORESAID AND THAT WE HAVE YOUR PERMISSION FOR YOUR YOUTH(S) TO PARTICIPATE IN THE ACTIVITIES AND TO HAVE TRANSPORTATION PROVIDED AS REQUIRED BY ACTIVITIES (Type name & date to sign below): *
MEDIA RELEASE: I consent to have my youth(s) to be interviewed, photographed, videotaped by authorized parties or designees of Good Journey Development Foundation. I also consent to have my student(s) participate in activities of Good Journey, under the auspices of Good Journey Development Foundation and to have any of the photographs (digital/paper), slides, computer images, videos, slide shows, and/or audio-television interviews used for public relations, news articles, advertising, research and or inclusion on Good Journey affiliated social medial and official websites. As parents/guardians, I waive all rights I may have to any claims for payments or royalties in connection with any of the publicity. I also waive all rights to inspect or approve any photo, video, film, interview as it relates to Good Journey Development Foundation when and if my child is a participant. I further consent to have all negatives and positives, whether prints, video film or sound recordings released to Good Journey Development Foundation, Inc. and recognize that all said materials are the property of Good Journey Development Foundation. *
I declare that I am legally eighteen (18) years or older and legally competent to execute the above media release. I consent to abide by these terms and I have voluntarily signed this document. I consent to hold harmless and release and forever discharge Good Journey Development Foundation from any claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf of my estate. I hereby certify that by signing this document, I do hereby give my consent without reservation to the Media Release for my youth(s) to be included in media and publicity efforts of Good Journey Development Foundation. My signature (TYPED NAME AND DATE BELOW) on this Media Release authorizes my willing consent hereby. (If you do not give consent, type NO on the line below.) *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy