Youth Job Skills Training Program Application

This program is for youth ages 15-25. Further details can be found HERE. A minimum of 40 hours is recommended to receive thorough training and to truly benefit from the experience. Applicants under the age of 18 are required to have their parents approve and complete the form. After we review the application, applicants will be invited to the Coffee House to meet the team and spend a few hours with us to be given a rundown of the program and the Coffee House, and to set up a schedule.

    APPLICANT'S INFORMATION

    Gender (required)

    CONTACT INFORMATION

    HEALTH FORM

    Do you grant EOS Staff permission to give over-the-counter medications if necessary?

    PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR ACCEPTANCE

    MEDICAL RELEASE:
    I authorize the administration of any first aid treatment necessary at the Youth Job Skills Training Program for myself/my child. In the case of a medical emergency, I authorize myself/my child to be transported by designated leaders or arrange for transportation to the nearest medical or hospital facility. In such an emergency I hereby give permission to the physician involved to secure proper treatment for myself/my child. In the event extraordinary transportation or medical treatment is required, I agree that Extreme Outreach cannot accept the financial responsibility. I expect the parent/guardian/emergency contact to be contacted as soon as possible.

    LIABILITY WAIVER:
    Extreme Outreach reserves the right to dismiss a participant who in their opinion is a hazard to the safety and the rights of others, or who appears to have rejected the program rules as directed by the designated leaders. I am confident that Extreme Outreach staff will do their best to give myself/my child the necessary support and supervision needed and I understand that the safety and health rules will be observed. To the best of my knowledge, myself/my child is in good health and physically, emotionally, and socially able to participate in all activities. I give myself/my child permission to participate in all activities. I hereby release Extreme Outreach Society and its personnel from all claims and damages arising from any accidents or injury caused by my/my child’s participation in the program or by any transportation to and from all locations. Extreme Outreach is not responsible for lost, stolen, or damaged items during my/my child’s participation. I agree that photos or videos of myself/my child taken at the Extreme Coffee House may be used in future Extreme Outreach and/or SuperKids promotional material. If I am not in agreement with this, I will give written notice to Extreme Outreach that the photos and videos are not to be used for this purpose. The parent/guardian submitting this application for an applicant under the age of 18 are those having legal custody over the youth.

    To indicate your understanding of the above, place a check mark in the box below and provide your full name and date:

    I understand & agree