Youth may complete a participant packet, and then a portfolio worksheet.
The Youth Legacy Foundation
Program Participation Forms
Last First Middle
Street City Zip
Driver – Yes No
Home Phone #
Participant Cell Phone # Text OK? Yes / No
Parent or Guardian Primary Phone # Text OK? Yes / No
Support Staff Primary Phone # Text OK? Yes / No
Parent or Guardian Email
Support Staff Email
Page 1 of 6
Nature of Duties: Volunteer Service
Days and Hours: When participant is available
Method of transportation: Provide own transportation
As a participant of The Youth Legacy Foundation, I understand that:
● I represent The Youth Legacy Foundation each time I am volunteering in the community and will act responsibly.
● I am accountable for my behavior.
● I will make safety a priority.
THIS DOCUMENT IS A RELEASE. IT MAY AFFECT YOUR RIGHTS. REVIEW CAREFULLY BEFORE SIGNING.
“We, the parents and participant named below, understand that the participant’s participation in The Youth Legacy Foundation program is voluntary. We understand that participation in the program, including travel between sites, involves a risk of injury. We have been informed of and agree to expressly accept and assume any and all risks of injury arising from such participation. We recognize that The Youth Legacy Foundation does not carry health or accident insurance or other insurance for medical and hospitalization expenses arising from such injuries. In consideration of being allowed to participate in The Youth Legacy Foundation program, we hereby agree to waive, release and forever discharge The Youth Legacy Foundation, its officers, directors, agents, from any and all liabilities from injuries or damages, or any act or omission, including negligence by The Youth Legacy Foundation representatives, arising out of or connected to the participation of the participant in The Youth Legacy Foundation program.”
By signing, you have agreed to follow the guidelines set by The Youth Legacy Foundation.
PARTICIPANT SIGNATURE DATE
If participant is under 18 years old OR over 18 years old and has a legal guardian:
Parent/Guardian PRINTED Signature
Parent/Guardian WRITTEN Signature
PLEASE NOTE: Parent signature may also be required on the 3rd page if you authorize
photos/videos to be taken of your participant during his or her participation.
QUESTIONS? Call Bridget Siljander – Executive Director
612-272-0281 or email@example.com
Page 2 of 6
2012-2013 Photo/Video Release Form
The Youth Legacy Foundation often uses photographs, video images, and other visual representations of participants in its print publications, communications, Internet pages/web sites, and on cable television. In addition, The Youth Legacy Foundation occasionally allows media or private groups to photograph participants, but requires written authorization for them to do so.
I hereby authorize photographs/videos to be taken of:
Home Phone #
Participant Signature (if more than 18 years old and without a legal guardian)
If you have questions about this procedure or The Youth Legacy Foundation’s use of participant photographs/images, please contact Bridget Siljander, the Executive Director, at 612-272-0281 or firstname.lastname@example.org.
Page 3 of 6
The Youth Legacy Foundation
Benefits and Activities
The Youth Legacy Foundation is a 501(c)(3) nonprofit organization that started in November 2011. We engage youth with disabilities in community volunteer activities, to grow in confidence and experience while making a difference. With an emphasis on legacy building, which is what makes us unique, we facilitate their leadership development.
Mission: To engage youth in humanitarian, charitable, and service activities to empower them to lead exemplary lives and create their legacies in the community while making a difference and changing the world.
Vision: That youth who identify as experiencing disability are actively participating in the community and building their legacies.
We NEED youth with disabilities.
They have much to offer and we need to make sure that they are included in our democracy and are able to achieve full community inclusion, access, and participation. We at The Youth Legacy Foundation know that with everyone’s support, we can make a difference and create a world that is better for all of us.
So what is a legacy? It is your mark on the world, and what you create during your lifetime that lives on. It is how you are remembered. Your legacy is about what you did during your lifetime for others, in service to your community. It is the difference that you make and the good that you do by giving of yourself and your talents and gifts.
Following are the current programs that The Youth Legacy Foundation offers. By participating in one or more of these programs, youth have the opportunity to gain experience as leaders emerging into adulthood.
- Individualized volunteer matching and facilitation
- Personalized support – in-person interview and follow-up meetings
- Customized portfolio using YLF process
- Adapted volunteer program – accommodations negotiated
- On-site coaching during volunteer activities
- Get active building your chosen legacy
- Develop competency and skill sets
- Increased employability
- Introduction to various community engagement opportunities
- Preparation for additional opportunities
- Demonstrate your abilities
- Make a difference and change the world
Page 4 of 6
- Based on portfolio and interview, connect with activities
- Mainstream leadership pursuits
- Coordination, referrals, and facilitation, networking across communities
- Community inclusion achieved in diverse community engagement
- Training around volunteerism, citizenship, and legacy building
- Celebrate community
- Foster disability power and pride
- Enhance creativity and enthusiasm
- Build resistance to bullying
- Expanded “life vision”
- Personal growth
- Assertiveness, positive attitude, self-confidence
- Public speaking
- Community inclusion and participation
- Self-directed living
- Recognition for your talents, abilities, and gifts
- Connect with disability leaders and industry professionals
- Supportive relationships that aid planning, activities, and legacy building
- Nurturing of life goals and dreams
- Expanded community access
- Increased opportunities to advance in education and employment
- Benefit from expertise and leadership of successful people
- Inspire entrepreneurial spirit and endeavors
- Peer support
- Enhanced learning
- Share experiences and personal growth
- Discuss progress in making a positive impact on communities
- Meet people of all backgrounds
- Make friends
- Participation in college/university student groups network – shared information, best practices, resources, ideas, experiences, and collective support
- Leverage your leadership
Following are some of the activities that our youth have been involved in include:
- Monthly Leadership Brunches
- Tuesdays at the Capitol
- Group volunteer Service Activities
- Self-Advocacy Conference – presenting and attending
- Art Activities
- Advisory Councils
- Feed My Starving Children
- Charity Events
- Pageant of Hope
- Interfaith Outreach and Community Partners
- Nursing homes and assisted living homes
- Local food shelves
- Park clean up
- Public policy activities
- Rallies at the state capitol
- Interviews on radio and television (and cohosting)
- Area hospitals – hospitality and pushing activity cart
- Service mission trips
“Wherever your passion leads you to serve the greater good while growing as a person…”
The Youth Legacy Foundation Mission:
The Youth Legacy Foundation engages youth in humanitarian, charitable, and service activities to empower them to lead exemplary lives and create their legacies in the community while making a difference and changing the world.
The Youth Legacy Foundation Vision:
Youth with disabilities are fully participating in community and building legacies.
For more information, contact Bridget Siljander, Executive Director at: email@example.com or 612-293-7008. Also, visit us on the web at www.youthlegacyfoundation.org and on Facebook at: www.facebook.com/youthlegacyfoundation.
© The Youth Legacy Foundation. All Rights Reserved.
Page 6 of 6