Teen Advisory Board

Teen Advisory Board members are encouraged to attend the Empower: Teen Leadership Summit. Teen Advisory Board members that are selected to serve on youth staff are required to attend a planning retreat prior to the Summit. Information about this initiative will be on the website.

Teen Advisory Board members are responsible for having safe, appropriate and reliable transportation to all scheduled meetings.

Teen Advisory Board members are expected to follow the law and members are asked to sign a drug-free pledge and make a commitment to being alcohol, tobacco and other-drug free.

Teen Advisory Board members will consider as confidential all information, which he or she may hear or see, directly or indirectly, concerning a patient, patient family member, doctor, or other health care professional.

Generally meetings are held Tuesday evenings from 6:00-8:00pm at Teen Health Connection, 3541 Randolph Road, Suite 206, Charlotte, North Carolina 28211 . Dinner is provided at all meetings and members are expected to notify the Teen Health Connection team if they are unable to attend. Make sure that you check the schedule for meetings dates and times.

There will be smaller committee meetings throughout the year with separate meetings assigned. You will be placed on a committee based on your interests.

By signing below, Teen Advisory Board members hereby certify that the answers on this application are true and correct and that any misrepresentations or omissions of facts, misleading, or false information will be grounds for dismissal from the Teen Advisory Board . All services are donated to Teen Health Connection without contemplation of compensation or future employment and given with humanitarian or charitable reasons.

 

I give permission for my child to serve as a Teen Advisory Board Member at Teen Health Connection . I understand that Teen Advisory Board Members are responsible for having safe, appropriate and reliable transportation to all meetings and events.

I hereby grant Teen Health Connection permission to use, re-use, exhibit, distribute, or publish
my and/or my child’s testimonials, images, artwork, portraits, pictures or videos for any Teen
Health Connection purpose including but not limited to Teen Health Connection illustrations, art,
videos, promotional materials, editorials, advertising, publications, websites or web content, all
without any compensation. I understand that any images, videos or artwork may be used at
exhibits and may identify me and/or my minor child. I relinquish any right that I may have to
inspect, examine or approve any completed product or products or any written or electronic
copy or other printed matter that may be used in conjunction with any of the foregoing. I
understand and agree that all materials containing the images or artwork of me and/or of my
minor child shall become the property of Teen Health Connection.

I hereby release, discharge and agree to forever hold harmless Teen Health Connection, its
legal representatives or assigns, and all persons or entities functioning under its permission or
authority from all and any claims, demands or causes of action ensuing from or in connection
with the use or publication of any of the foregoing including without limitation any claims for libel
or invasion of privacy. This authorization and release shall inure to the benefit of the legal
representatives, licensees and assigns of Teen Health Connection and shall be binding upon
me and upon my estate, my heirs and my legal representatives.

I have read and fully understand the content, meaning and impact of the forgoing and represent
that I am the individual named below. I agree that I am over the age of majority or that I am the
parent or legal guardian of the minor child named below, am over the age of majority, and
hereby consent to the foregoing on behalf of such minor child named below.

 

I pledge to lead the way by:

• living an alcohol, tobacco and other drug-free life.
• talking to my friends about the dangers of abusing alcohol, tobacco and other drugs.
• learning more about the harmful effects of alcohol, tobacco, and other drug use.
• working collaboratively with others to ensure that every adolescent is healthy, safe, and successful.