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City of Prescott

201 S. Cortez Street, Prescott, AZ, 86303, US

Youth Advisory Board Application

The purpose of the Youth Advisory Board is to provide a coordinated effort and central body to act on issues related to youth in the Prescott community. The board is an advisory board to City Council and the Mayor, acting through the City Manager. The initial term length for all participants will be 18 months, beginning in January 2019. The mission of the board is to provide insight and feedback on issues relating to youth, including city ordinances, long range planning, and city-school district relations. The board seeks to enable youth to participate in improving the quality of life in the community.

The deadline to apply is November 30th. Board members are expected to attend all meetings of the board or commission unless otherwise excused. These meetings will occur on the third Tuesday of each month after normal school hours. Applicants are encouraged to review board information, including meeting dates and times, to ensure attendance requirements can be met.

Full Name

Full Address

Age and Current Grade

High School Graduation

Please upload one (1) letter of recommendation from a teacher, coach, or leader that demonstrates how you would be a valuable member of the board.

PARENTAL PERMISSION FORM I grant permission for my child, named above, to participate in the YOUTH ADVISORY BOARD AND RELATED ACTIVITIES (“YAB”). To the maximum extent permitted by law, I for myself and for my child and and my/their respective estates, heirs and assigns, hereby agree to indemnify, defend and hold harmless the CITY, its elected officials, departments and divisions, employees and agents (collectively, “Indemnitees”), from any and all claims, liabilities, expenses or lawsuits as a result of my child’s participation in the YAB, including transportation to or from any portion of the program. I also for myself and on behalf of my child further release and discharge the CITY, its elected officials, departments and divisions, agents and employees, and any and all persons legally responsible for the acts or omissions of the CITY, from any and all claims which such persons have or may have against the CITY, its elected officials, agents or employees, arising out of or in any way connected with the activities as set forth herein. I additionally permit the free use of my child’s name and picture in broadcasts, newspapers, etc. I understand that during the activity my child may be photographed or videotaped. To the fullest extent allowed by law, I waive all rights of publicity or privacy or pre-approval that my child has for any such likeness or use of his/her name in connection with such likeness, and I grant to Prescott and its assigns permission to copyright, use, and publish (including by electronic means) such likeness of me, whether in whole or part, in any form, without restrictions, and for any purpose.

Parent or Guardian Signature

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