Safe support for young people

Youth Registration & Guardian Consent

A parent or legal guardian must complete this form before a child or teen participates. The registration is saved securely in the Rooted & Rising system and the team is notified automatically.

Safeguarding commitments

Age-appropriate activities and respectful communication.
Guardian authorization before participation.
Emergency contact and health information available only to authorized staff who need it for program safety.
No private transportation or one-on-one off-site contact without written guardian authorization.
Concerns about a young person’s immediate safety are escalated to emergency services or appropriate authorities when required.
Rooted & Rising programming is educational and supportive; it is not clinical therapy, crisis care, or emergency treatment.

Participant information

Young Person’s Full NameDate of BirthProgram Interest

Parent or guardian

Guardian Full NameRelationship to ParticipantGuardian EmailGuardian Phone

Emergency and health information

Emergency Contact NameEmergency Contact PhoneAllergies, Medications, Medical Needs, or AccommodationsAuthorized Pickup Adults

Permissions

I am the parent or legal guardian and authorize participation in the selected Rooted & Rising program or event.I authorize staff to contact emergency services when reasonably necessary and understand that I remain responsible for medical costs.Photo and Media PermissionI confirm that the information provided is accurate and will notify Rooted & Rising of material changes.Guardian Signature

After submission, the guardian receives a confirmation email. The Rooted & Rising team receives a notification and a high-priority follow-up task. Private health, consent, emergency, and pickup details remain in the protected enrollment record.