2025 ADGA National Convention

Youth Information

Youth Name(Required)
Date of Birth(Required)
Please provide the youth member’s date of birth
Clear Signature
Signature of Youth Participant
Youth Accomodations
If you would like to request learning or physical accommodations (i.e. during the management contest examination), please detail those below.
YOUTH ACTIVITIES CODE OF CONDUCT (Youth Consent)(Required)

Parent/Gaurdian Information

Parent/Gaurdian Name(Required)
Optional additional phone number
Clear Signature
Signature of Parent/Gaurdian
YOUTH ACTIVITIES CODE OF CONDUCT (Parent/Guardian Consent)(Required)
MEDICAL CONSENT(Required)
Allergy and known medical or physical conditions(Required)
Following are any food or drugs to which the above named is allergic, as well as any other information, medical or physical, that should be known.
Please list your health insurance provider
Please list your health insurance number
PARTICIPATION AND ADVERTISING AGREEMENT(Required)

ONSITE AUTHORIZED PARENT OR GUARDIAN

Each participant in the youth activities at the ADGA Annual Convention is required to have an identified adult chaperone (over age 21) who is responsible for that youth. This must be a person who will be present at the Annual Convention during the youth events. This person will be contacted and held responsible for the youth should a code of conduct violation occur.
Name of Designated Chaperone(Required)
State in which Chaperone resides(Required)

NOTE

If the adult chaperone is someone other than the youth’s parent/ guardian, it is the responsibility of the parent/guardian to notify the individual and obtain his/her permission to be listed as the designated chaperone. The designated chaperone should also have the youth’s health and insurance related information available in case of an emergency.
This field is for validation purposes and should be left unchanged.