YEAH Youth Ambassador Application

YEAH Youth Ambassador Application

Parent or Guardian Media Release
Youth Encouraging Alaskans Health (YEAH) Youth Ambassadors is a statewide youth group focused on community health and wellness.

Youth Ambassadors, ages 13 to 18, partner with Youth Activities Coordinators--or other supportive adults in their community who help plan and do fun activities.

Throughout the year, Youth Ambassadors meet online or in person to have fun and receive training in a wide range of skills. They also learn to engage their peers at schools and conferences and create informative content about healthy living for social media.

Each year, YEAH hosts a summit in which Youth Ambassadors plan and lead a three-day event, usually in Anchorage. Youth Ambassadors lead activities with other youth from around the state and talk about the issues they find most important, creating a fun and engaging environment where peers from across the state can learn about healthy activities, substance prevention and advocacy
efforts.

Join us if you're interested in meeting new people, improving your public speaking and presentation skills, gaining a deeper understanding of important issues to Alaska youth.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Birth Date*

MonthDayYear
Date
Contact Phone Number*
Please enter a valid phone number.
Grade in School as of Fall 2025*

12thCollege
Have you participated in youth groups or groups promoting healthy activities before?*

YesNo
Describe your experience working with other youth:*
Describe your interest in becoming a Youth Ambassador in your community:*
List clubs in high school, after-school activities, sports or other programs you participate in:*
Who is your local Youth Activities Coordinator?*

First NameLast Name
Phone Number for Youth Activities Coordinator*
Please enter a valid phone number.
Email Address for Youth Activities Coordinator*
example@example.com
Parent/Guardians Email Address*
Valid email address for the approval and media release form to be sent to.
Youth Ambassador Parents and Legal Guardians Media Release
Hello Youth Ambassador Parents and Legal Guardians. Below is the media release that is required to participate in the Youth Ambassador Program. Please fill out the form below.
I'm voluntarily signing this release form which gives the Rural Alaska Community Action Program, Inc. (RurAL CAP) permission to use photographs, video, audio recordings, and/or textual material, taken of me and/or my child for use in external or internal publications, including but not limited to web sites, electronic forms of media, and funder/partner publications. In doing so, I have confidence RurAL CAP will use this form of media with the utmost respect. I give up my right to inspect or approve the photographs, publications, or electronic matter that may be used now or in the future, and I waive any right to royalties or other compensation arising from or related to the use of the photographs or other media.
I agree to hold harmless RurAL CAP from and against any claims, damages or liability arising from or related to the use of the photographs or other media.
I am the parent or legal guardian of the below named child. I have read this release before electronically signing below, and I fully understand the contents, meaning, and impact of this release.
Parent/Guardian's Signature

Clear
Should be Empty:

YEAH Youth Ambassador Application

Youth Ambassador Parents and Legal Guardians Media Release