Youth Program

Youth Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

I am the parent/legal guardian of the minor child named above. I have received a request for consent for my child to be digitally recorded for audio and/or video podcasts that are being recorded as part of a Next Gen Men initiative, and agree to using this digital form in the place of written signature. *

I agree

I do not agree

I give permission to Next Gen Men to include my child’s voice and/or image or likeness in media, articles or podcasts as they participate in one or more programs conducted by Next Gen Men and/or to reproduce materials that my child may produce as part of the program activities. No last names will appear on any materials or broadcast. *

I give permission

I do not give permission