henrico pal
HENRICO PAL YOUTH LEADERSHIP COUNCIL
The Henrico Police Athletic League Youth Leadership Council is designed to expose career minded youth from ages 12 to 18 years old to the many facets of leadership development and community service. Participants will meet and receive instruction from government, private industry, and community leaders. All participants will engage in various leadership related projects and activities. Participants will also engage in community service projects monthly. Each perspective participant must be available to attend the monthly meetings on the 2nd and 4th Mondays of each month @ 6:00 pm. Each participant is required to adhere to and sign the YLC Bylaws/Code of Conduct Agreement and maintain at least a 2.5 grade point average. An example of the YLC annual events & highlights:
$1000. scholarship awarded to one H. S. Senior entering college annually Over 90% of participants go on to college Attend the Annual Region 6 Youth Leadership Retreat typically held out of state Past President was the 2011 National PAL Male Youth of the Year Winner College Tours Leadership Workshops Various Community Service Projects
All interested youths must fill out a registration form accompanied by a one page typed letter from the youth stating why he/she should be selected to participate in the Henrico PAL YLC. For more information please call (804) 262-4725 or visit www.henricopal.org
Henrico Police Athletic League Youth Leadership Council and WAIVER Registration Form
Child’s Birth Name __________________________________ Nick Name ____________________ Parents/Guardians________________________________________________________________ Address________________________________________________________________________ Zip Code ____________________ Henrico County Resident_____________ (YES OR NO) Telephone (H)___________________(W)__________________ (Cell)______________________ Emergency Telephone___________ Emergency Contact Person __________________________ Date of Birth____________________ Age_________ (12-18) Male / Female T-Shirt Size______ School __________________________ (Indicate youth or adult size) Middle School GPA ________________ High School GPA ________________ Did your child attend any Henrico PAL sponsored programs previously? Y / N Officer/Counselor ____________________ Email address: ________________________________________________________________ (Please write legibly)
Mail completed form and one page letter to: Henrico PAL, 8655 Staples Mill Rd, Henrico, VA 23228 REGULATIONS: To be eligible to participate in the Youth Leadership Council, a participant and his/her parent or guardian must completely fill out and properly sign this form attesting that the participant is physically fit for athletic and/or recreational activities and that the parent or guardian consents to such participation. A physical medical examination, while not Compulsory, is highly recommended prior to participating in any department sponsored recreational program. Accident insurance is recommended for all participants in any Henrico PAL sponsored recreational program and it is the responsibility of the parent/guardian to provide such insurance. PARTICIPATION CONTRACT: We hereby verify that the above information is true and correct, and that (participant’s name) _________________________________ is physically fit to participate in the YLC. We understand that any false information will result in the loss of program privileges and immediate suspension from the YLC noted below for the remainder of the year. The participant agrees to comply with the rules and regulations established by the Henrico Police Athletic League. PARENTAL CONSENT AND WAIVER: I hereby consent to and approve of the above named child participating in the Henrico PAL Youth Leadership Council. I understand the risks associated with participating in this program and hereby waive, for myself and the above named child, any and all claims, demands and right of action against the County of Henrico, and the Henrico Police Athletic League employees, coaches and officials of the league for any injury or accident which may occur to the said child as a result of participating in this program. The parent(s) and/or guardian(s) consent to and understand that photographs and/or images captured during the Youth Leadership Council may be utilized in Henrico PAL literature and advertisement. *Parent/Guardian Signature___________________________
Date______________
OFFICE USE ONLY Accepted Y/N ____________ Notified Y/N __________ Staff Initials ____________ YLP #___________
The Henrico Police Athletic League Youth Leadership Council is designed to expose career minded youth from ages 12 to 18 years old to the many facets of leadership development and community service. Participants will meet and receive instruction from government, private industry, and community leaders. All participants will engage in various leadership related projects and activities. Participants will also engage in community service projects monthly. Each perspective participant must be available to attend the monthly meetings on the 2nd and 4th Mondays of each month @ 6:00 pm. Each participant is required to adhere to and sign the YLC Bylaws/Code of Conduct Agreement and maintain at least a 2.5 grade point average. An example of the YLC annual events & highlights:
$1000. scholarship awarded to one H. S. Senior entering college annually Over 90% of participants go on to college Attend the Annual Region 6 Youth Leadership Retreat typically held out of state Past President was the 2011 National PAL Male Youth of the Year Winner College Tours Leadership Workshops Various Community Service Projects
All interested youths must fill out a registration form accompanied by a one page typed letter from the youth stating why he/she should be selected to participate in the Henrico PAL YLC. For more information please call (804) 262-4725 or visit www.henricopal.org
Henrico Police Athletic League Youth Leadership Council and WAIVER Registration Form
Child’s Birth Name __________________________________ Nick Name ____________________ Parents/Guardians________________________________________________________________ Address________________________________________________________________________ Zip Code ____________________ Henrico County Resident_____________ (YES OR NO) Telephone (H)___________________(W)__________________ (Cell)______________________ Emergency Telephone___________ Emergency Contact Person __________________________ Date of Birth____________________ Age_________ (12-18) Male / Female T-Shirt Size______ School __________________________ (Indicate youth or adult size) Middle School GPA ________________ High School GPA ________________ Did your child attend any Henrico PAL sponsored programs previously? Y / N Officer/Counselor ____________________ Email address: ________________________________________________________________ (Please write legibly)
Mail completed form and one page letter to: Henrico PAL, 8655 Staples Mill Rd, Henrico, VA 23228 REGULATIONS: To be eligible to participate in the Youth Leadership Council, a participant and his/her parent or guardian must completely fill out and properly sign this form attesting that the participant is physically fit for athletic and/or recreational activities and that the parent or guardian consents to such participation. A physical medical examination, while not Compulsory, is highly recommended prior to participating in any department sponsored recreational program. Accident insurance is recommended for all participants in any Henrico PAL sponsored recreational program and it is the responsibility of the parent/guardian to provide such insurance. PARTICIPATION CONTRACT: We hereby verify that the above information is true and correct, and that (participant’s name) _________________________________ is physically fit to participate in the YLC. We understand that any false information will result in the loss of program privileges and immediate suspension from the YLC noted below for the remainder of the year. The participant agrees to comply with the rules and regulations established by the Henrico Police Athletic League. PARENTAL CONSENT AND WAIVER: I hereby consent to and approve of the above named child participating in the Henrico PAL Youth Leadership Council. I understand the risks associated with participating in this program and hereby waive, for myself and the above named child, any and all claims, demands and right of action against the County of Henrico, and the Henrico Police Athletic League employees, coaches and officials of the league for any injury or accident which may occur to the said child as a result of participating in this program. The parent(s) and/or guardian(s) consent to and understand that photographs and/or images captured during the Youth Leadership Council may be utilized in Henrico PAL literature and advertisement. *Parent/Guardian Signature___________________________
Date______________
OFFICE USE ONLY Accepted Y/N ____________ Notified Y/N __________ Staff Initials ____________ YLP #___________
