CADCA 2019 Mid-Year Training Institute Parent/Guardian Consent Form
2019 CADCA Mid-Year Training Institute
July 14-18, 2019 Gaylord Texan Hotel Dallas, TX
Statement of Informed Consent for Parents/Guardians
This parent/guardian consent form is required for ALL youth attending CADCA’s 2019 Mid-Year Training Institute. Community Anti-Drug Coalitions of America (CADCA) is a nonprofit organization headquartered in Alexandria, Virginia whose mission is to create and maintain safe, healthy and drug free communities globally. Forum is made up of youth and adult training sessions aimed at making coalitions smarter, faster.

If you agree to have your child participate in this training, he/she will be expected to participate in a comprehensive training course with his/her adult advisor who has agreed to assume responsibility for him/her while traveling and during the event. No anticipated personal risks will occur as a result of participation in this training. All data obtained will be treated with the highest level of confidentiality.

The youth training offered is through CADCA’s Youth Leadership Courses. CADCA's Youth Leadership Courses enhances the effectiveness of youth and their coalition advisor within community coalitions. It empowers thousands of young people yearly to get involved in the community problem-solving process to the development of safe, healthy and drug free communities.

Photograph/Video Waiver
By submitting this form, you give permission to CADCA to use photographs, videotapes, film and audio in which your youth appear as a participant for educational and publicity/promotional purposes for or related to CADCA’s and/or the coalition’s work. These can also be used by CADCA in published materials.
Permission for Medical Treatment
In the event of an emergency in which the parent/guardian cannot be contacted, emergency medical staff, the adult advisor(s) and CADCA may take appropriate action as needed.
General Release of Liability
The undersigned agrees to release, waive, discharge, and hold harmless CADCA, its directors, officers, employees, agents, and volunteers from any and all claims, suits, losses, or related causes of action for damages during or arising in any way from participation in this training event. You are being asked whether or not you will permit your child to participate in this training. If you wish to give permission to participate, and you agree with the statement below, please check the box below.
*
Required
Youth's Name (First & Last): *
Your answer
Youth's Age: *
Your answer
Youth's Date of Birth: *
Your answer
Demographic Information of Youth (This allows us to better serve our coalitions)(check all that apply) *
Required
If checked "other", please provide your demographic information below:
Your answer
Course Youth is Attending: *
Signatures
The "digital signatures" to be provided below are not actual written signatures, however they are held to the same standards and legality as an official signing. Simply type the requested name into the required space.
*
Required
Parent/Guardian Signature: *
Your answer
Primary Phone Number: *
Your answer
Secondary Phone Number:
Your answer
Email Address: *
Your answer
Home Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
On-Site Adult Advisor Name: *
Your answer
On-site Adult Advisor Cell Phone Number: *
Your answer
On-site Adult Advisor Email Address: *
Your answer
Coalition Name: *
Your answer
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