Do not fill this out

The Heights Movement

Summer Youth Employment Program Orientation Form

Please complete this form before or during orientation. This form helps us confirm contact information, emergency contacts, medical needs, program rules, media permission, transportation permission, and track interests.

Important: Do not enter Social Security numbers or tax ID numbers on this form. W-9 forms must be completed in person or through a secure payroll process.

Youth Participant Information

First Name *

Last Name *

Date of Birth *

Age *

Youth Phone Number *

Youth Email

Home Address *

City *

Zip Code *

Parent / Guardian Information

Parent/Guardian Name

Relationship to Youth

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

Alternate Phone

Medical / Allergy Information

Does the youth have any allergies? *

Medical conditions, medications, or health concerns staff should know about?

Food restrictions or dietary needs?

Program Track Interest

Primary Track Interest *

Other Tracks of Interest

Urban Agriculture Electronic Storytelling / Media Community Engagement Entrepreneurship / Business Building Youth Camp Support Wellness / Reset Track Beautification / Site Projects

What do you want to gain from this summer besides money? *

Availability & Transportation

What days/times are you available this summer? *

How will you get to the program? *

Transportation notes or concerns

Media Release

The Heights Movement may take photos, videos, and interviews during programming for reports, social media, newsletters, grants, flyers, and community storytelling.

Media Permission *

THM Rules & Code of Conduct

I agree to be respectful to staff, youth, community members, and property. I agree to show up on time and communicate if I am late or absent. I agree to follow safety instructions and ask before using tools or equipment. I understand fighting, bullying, threats, harassment, weapons, drugs, alcohol, vaping, or smoking are not allowed. I agree to represent The Heights Movement positively in person, online, and in the community. I understand that repeated behavior issues may lead to parent/guardian contact, suspension, removal from work duties, or dismissal from the program.

Payroll / W-9 Acknowledgment

This website form does not collect Social Security numbers or tax ID numbers. Staff will provide instructions for completing the official W-9 securely.

W-9 / Payroll Status *

Volunteer Section

Are you signing up as a volunteer?

Volunteer skills, interests, or ways you want to help

Final Agreement

Youth Participant Full Name as Signature *

Parent/Guardian Full Name as Signature, if youth is under 18

Date *

Anything else THM staff should know?

By submitting this form, the participant and/or parent/guardian confirms that the information provided is accurate and that they understand The Heights Movement Summer Youth Employment Program expectations.

SUPPORT

CONTACT

info@theheightsmovement.com