Y2Y First Friday 2024-2025 Participant Form

Y2Y First Friday Participant Sign-Up

2024-2025 School Year
First Friday

First Friday is a program that focuses on providing middle schoolers with the skills to make decisions surrounding bullying, alcohol, tobacco, and other drugs, stress, relationships, peer pressure, etc. Our goal is to create a supportive environment where they feel comfortable learning, using their voice, and developing healthy relationships with their peers and professional staff.

The sessions will take place at our Youth to Youth office, located at 118 E Main Street Columbus, OH 43215, from 6:00pm - 8:00 pm on the dates below.
We would love for your student to participate in all sessions, but understand scheduling conflicts may not make that possible. Please select all dates your student will be able to attend:*

September 6, 2024October 4, 2024November 1, 2024February 7, 2025March 7, 2025April 4, 2025
Participant Information
For the safety of each student, we require all participants in any Youth to Youth program to have annually completed Medical Forms and Parent Authorizations. This form must be completed by the participant's parent or legal guardian. Signature Authorizations will be required at the end of the form.
Student Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student's Birth Date*

MonthDayYear
Date
Gender Identity*
Race/Ethnicity
Participant demographics are requested by our funder.
School*
Grade (2024-2025 school year)*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/ Guardian Email*

Confirmation Email
Medical Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to Participant*
Emergency Contact Phone Number*
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Participant
Alternate Emergency Contact Phone Number
Does the participant have any medical conditions we should be aware of?*

YesNo
Please explain medical condition*
Does the participant have any environmental, food, or drug allergies?*

YesNo
Environmental, food, and/or drug allergies*
Allergy Reaction*
Do any of the allergies cause a risk for anaphylaxis?*

YesNo
Will the participant be bringing an Epi-Pen?*

YesNo
Does the participant have any dietary restrictions we should be aware of?*

NoneVegetarianVeganGluten-freeDairy-free/Lactose intoleranceOther
Does the participant have any physical limitations we should be aware of?*

YesNo
Please explain physical limitations*
If needed, can a staff member administer Acetaminophen/Tylenol?*

YesNo
If needed, can a staff member administer Ibuprofen/Advil?*

YesNo
Authorizations
EMERGENCY MEDICAL RELEASE

I being the natural parent/legal guardian hereby grant CompDrug/Youth to Youth, an Ohio, not-for-profit corporation, or its designee the right to transport the above captioned minor to any emergency medical or health care facility for immediate treatment and/or consultation, if necessary. Further, I hereby grant CompDrug’s medical designee, the right to consent to medical treatment on behalf of the above captioned minor. I understand that I will be notified of any emergency situation as soon as reasonably practical, but that this Emergency Medical Release may be utilized in the event that I am unavailable to provide necessary consent, and immediate authorization for treatment required. This release is effective for: September 6, 2024 - April 4, 2025.
EVALUATION RELEASE

I being the natural parent/legal guardian give my permission for my child to complete Youth to Youth evaluations. I also give permission for my child to participate in post-program surveys and evaluations. I understand that data collected will be used for future program development.
PHOTO RELEASE

I understand that pictures and/or videos of my child may be taken and hereby agree and consent to the use of these pictures/videos by Youth to Youth or its sponsoring organization CompDrug for promotional purposes.
RULES AND REGULATIONS   

These rules are designed to ensure that all participants of Youth to Youth enjoy a maximum learning experience in an environment conducive to the exchange and sharing of ideas and concepts.  All participants are expected to adhere to the rules as outlined herein, or may be established from time to time by Youth to Youth.  Any violation of these rules may result in either a private discussion with a member of the Youth to Youth staff or immediate removal from the program or event.  Enforcement and supervision of these rules shall be at the sole discretion and judgment of Youth to Youth.  Parents/Legal Guardians will be responsible for transportation if their teen is removed from the program or event.  All expense or cost associated with the participant’s removal from the program shall be the responsibility of the participant’s parent/legal guardian.   
 
Attendance: Participants must arrive and be picked up in on time.  
Behavior: Participants are expected to conduct themselves in a mature and orderly manner at all times. 
Use of Drugs or Alcohol: Participants either found using or under the influence or in possession of alcohol, tobacco, and/or other drugs, will be removed from the program or event.
Sexual Activity/Violence: No sexual activity, acts of aggression or violence are permitted. 

 
As parent/legal guardian, I have read the rules and regulations on this form and have discussed them with my child.  My child understands all the rules and regulations and agrees, as do I, to abide by them.  I agree to indemnify and hold the Youth to Youth program and its’ sponsoring organization CompDrug, as well as the local sponsor and any of their agents and employees harmless from and against all claims, damages, cause of action or other liabilities cause by my violation of any of the rules and regulations contained in this agreement or established by Youth to Youth from time to time.   
I, Parent First Name Last Name , being the parent/legal guardian of Child First Name Last Name , agree to the terms and conditions outlined in the following authorizations:
Authorizations*

Emergency Medical Release (required to participate)Photo Release (optional)Evaluation Release (required to participate)Rules and Regulations (required to participate)
Signature*

Clear
Signed authorization agreeing to the Emergency Medical Release, Evaluation Release, and Rules and Regulations are all required to participate in the Y2Y First Friday. If you would like your student to participate, please make sure each is checked signifying your authorization.
Should be Empty:

Y2Y First Friday Participant Sign-Up

Participant Information

Medical Information

Authorizations