Youth Tour Materials

If you prefer, click here to download forms for print then email to: [email protected]

2025 Youth Tour Parent/Legal Guardian Information Section

Name of Parent(s) or Legal Guardian(s)*
First Middle Last
Name of Parent(s) or Legal Guardian(s)
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Email*
Parent/Guardian Phone Numbers*
Home
Work
Work
Cell
Cell
Son/Daughter Name
First Last
2024 Youth Tour Permission Statement*
I hereby grant permission for my son/daughter (name above) to represent our Electric Cooperative on NRECA Youth Tour, June 16-20, 2025 and sponsored by the Virginia, Maryland & Delaware Association of Electric Cooperatives (VMDAEC). I further authorize and direct the VMDAEC through its chaperones and Tour Director on said trip to direct and supervise our child. I understand my/our son/daughter will travel by car/bus from June 16-20, 2025 with chaperones from our Electric Cooperative and VMDAEC staff and that both photo and video images including him/her will be taken and posted on social media and photo sharing sites for possible use by their co-op, VMDAEC and NRECA in various publications and online outlets.
By checking this box and typing my name below, I am electronically signing this statement.
Signature
First Last
Date
MM slash DD slash YYYY

If you prefer, click here to download forms for print then email to: [email protected]

2025 Youth Tour Parent/Legal Guardian Medical Permission Form

Parent or Legal Guardian
First Last
Parent or Legal Guardian
First Last
Name of Child
First Last
2024 Youth Tour Medical Permission Form*
I/We the undersigned parents or legal guardians (name above) desire that our child (name above) shall have the opportunity to visit Washington, DC from June 16-20, 2025, sponsored by the Virginia, Maryland & Delaware Association of Electric Cooperatives (VMDAEC) do consent to our child taking such trip. It is understood that our child will travel by car and bus from June 16-20, 2025. Chaperones from our Electric Cooperatives and VMDAEC will accompany the group on this trip. We further authorize and direct the VMDAEC through its chaperone and Tour Director on said trip to direct and supervise our said child; and we further request and authorize the VMDAEC through its chaperones and Tour Director to secure any medical or other emergency services the said chaperones or Tour Director, in their reasonable discretion, may believe to be necessary or desirable for our child during such trip.
By checking this box and typing my name below, I am electronically signing this statement.
Signature
First Last
Date
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Email
Phone
Family Medical Insurance Policy Information*
Name of Company Policy Number Named Insured (of family's health insurance policy) Relationship
Scan and upload a copy of both sides of medical card*
Drop files here or

Max. file size: 50 MB.

If you prefer, click here to download forms for print then email to: [email protected]

2025 Youth Tour Delegate Designation of Beneficiary Insurance Policy

The insurance policy covers the following if occurring during the Youth Tour:

$10,000 benefit for death or dismemberment
$10,000 Accidental Medical Expense Benefit ($25 Deductible)
$1,500 Sickness Medical Expenses for injuries and illnesses ($25 Deductible) e.g., colds, flu, diseases, broken bones, etc.).

*This is a supplemental policy to the medical plan in effect for the participant. All claims must first be filed with the individual’s effective medical plan and any amount not covered under that plan can then be submitted to NRECA for payment.

2025 Youth Delegate Designation of Beneficiary Insurance Policy

I,*

Youth Delegate Name
of
City State ZIP Code
DO HEREBY DESIGNATE

Name of Beneficiary(ies)
of
Beneficiary Street Address Address Line 2 City State ZIP Code
2025 Youth Delegate Designation of Beneficiary Insurance Policy*
I understand that this supplemental coverage will be in effect June 16-20, 2025 from the time the student leaves on the Youth Tour trip until he/she returns home.
By checking this box and typing my name below, I am electronically signing this statement.
Student Signature
Student Name
First Last
Date
MM slash DD slash YYYY
The insurance policy* covers the following if occurring during the Youth Tour: • $10,000 benefit for death or dismemberment • $10,000 Accidental Medical Expense Benefit ($25 Deductible) • $1,500 Sickness Medical Expenses for injuries and illnesses ($25 Deductible) (e.g., colds, flu, diseases, broken bones, etc.). *This is a supplemental policy to the medical plan in effect for the participant. All claims must first be filed with the individual’s effective medical plan and any amount not covered under that plan can then be submitted to NRECA for payment.
List any pertinent information we need to know about your child (medication, allergies, etc.) Type N/A for none.*

Please submit these pgs. 3-5

If you prefer, click here to download forms for print then email to: [email protected]

2025 Youth Tour Consent for Medical Treatment, Liability and Publicity Release Form

Youth's Full Name*
First Last
Consent for Medical Treatment, Liability and Publicity Release Form*
READ THIS FORM COMPLETELY AND CAREFULLY AS THIS DOCUMENT IMPACTS IMPORTANT LEGAL RIGHTS. I/We the undersigned parent(s) or guardian(s) of (youth’s full name listed above) give my/our consent for him/her to participate in Youth Tour from Sunday, June 19, 2023, through Thursday, June 23, 2023 sponsored by the Virginia, Maryland and Delaware Association of Electric Cooperatives (VMDAEC). I/We understand that this participation involves travel within and outside Virginia, Maryland, and Delaware. I/We authorize and direct VMDAEC, through their staffs and volunteer chaperones, to direct and supervise my/our son/daughter. I/We further request and authorize VMDAEC through their staffs and volunteer chaperones, to secure any medical or other emergency services the said staffs and volunteer chaperones in their reasonable discretion may deem necessary or desirable for my/our son/daughter, and to otherwise proceed to care for my/our son/daughter in place of myself/ourselves as parents. I/We further release VMDAEC staffs, volunteer chaperones, or other professional person of any claim whatsoever on account of first aid or medical treatment or services rendered at the Youth Tour. In the event that my son/daughter is unable to consent to emergency medical treatment, I/we authorize and consent to emergency medical care to be given as the judgment of medical personnel dictate. I/We will provide necessary medical information, including allergies, preexisting medical conditions, and necessary medications, to the VMDAEC staffs or chaperones. I/We hereby release and agree to hold harmless VMDAEC, NRECA, their Members, officers, members, staffs, and associated organizations and volunteer chaperones, together with their heirs, successors, or assigns from any and all causes of action, claims, damages, costs, expenses, compensation, personal injury, property loss, any other loss or injury, any and every demand, action or right of action, of whatever kind or nature, either at law or in equity, related to or arising out of participation by my/our son/daughter during his/her participation in the Youth Tour. I/we assume all risks associated with said participation. I/we hereby grant free permission to VMDAEC and NRECA to use photographs, likenesses, and/or video images of my/our son/daughter for publicity purposes related to this activity, in all media, in whatever form, in perpetuity.
By checking this box and typing my name below, I am electronically signing this statement.
Signed at*
City State / Province / Region
Date*
MM slash DD slash YYYY
Parent/Guardian Signature*
Parent/Guardian Name*
First Last
Date
MM slash DD slash YYYY
Parent/Guardian Signature (if applicable)
Parent/Guardian Name (if applicable)
First Last
Date (if applicable)
MM slash DD slash YYYY

If you prefer, click here to download forms for print then email to: [email protected]

2025 NRECA Youth Leadership Council (YLC) Application

State(Required)

Applicant Name:(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Age(Required)

Date of Birth(Required)

T-Shirt Size(Required)

Parent/Guardian Name(s):(Required)

First Last

Emergency Contact Name(Required)

First Middle Last

Relationship(Required)

Emergency Contact Phone(Required)

City and Airport Closest to Your Home:(Required)

Approximate Driving Time to Airport:(Required)

Local Newspaper Name:(Required)

Local Newspaper Address(Required)

Street Address Address Line 2 City State ZIP Code

Sponsoring Cooperative:(Required)

Address of Cooperative:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cooperative Phone(Required)

Part 1: School Information

School Name:(Required)

School Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School Phone:(Required)

School Fax:

Name of Principal:(Required)

First Last

Current Grade Level:(Required)

GPA (on 4.0 scale):(Required)

Major/Study of Interest:(Required)

Career Goal:(Required)

Please list activities you have participated in and any special honors you have received during your high school attendance (e.g., class officer, plays/music/arts, athletics, etc.)

ACTIVITY/HONOR:(Required)

Include years participated.

Additional Remarks/Notes:

Part 2: Extracurricular Activities

Please list extracurricular activities and clubs you have participated in (e.g., FFA, FHA, church/community service clubs, science club, etc.)

ACTIVITY/HONOR:(Required)

Include years participated.

Additional Remarks/Notes:

Please list any experience with public speaking:

Please list any writing experience (school newspaper, yearbook, etc.):

STATEWIDE CONTACT INFORMATION Dathie Washington
Youth Tour Director
[email protected] (804) 297-3487

2025 NRECA Youth Leadership Council (YLC) Permission & Medical Release Form

This form is required if your child plans to apply for one of the YLC positions representing Virginia, Maryland, or Delaware.

Child's Name(Required)

First Middle Last

State(Required)

We, the undersigned parents/guardians, desiring that our child (name listed above) shall have the opportunity to participate as a member of the Youth Consulting Board of NRECA representing the State of (state listed above) from June 17-21, 2024, do consent to our child participating in all activities and functions (including travel to and from conferences and meetings) related to the duties and responsibilities of the Youth Leadership Council. This form is required if your child plans to apply for one of the YLC positions representing Virginia, Maryland, or Delaware. We further authorize and direct any designated chaperones in their reasonable discretion to secure medical and/or other emergency services that the said chaperone may believe to be necessary or desirable for the Youth Consulting Board member during their time in office.

Signed at:(Required)

City, State

this(Required)

date

Parent/Guardian Signature:(Required)

Parent/Guardian Signature:

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone

Cell

Phone

Mobile

Phone

Work

STATEWIDE CONTACT INFORMATION Dathie Washington
Youth Tour Director
[email protected] (804) 297-3487

Questions please contact Dathie Washington at [email protected] or call 804-297-3487.

2025 Youth Tour Delegate Information Sheet

2025 Youth Tour Parent/Legal Guardian Information Section

2025 Youth Tour Parent/Legal Guardian Medical Permission Form

2025 Youth Tour Delegate Designation of Beneficiary Insurance Policy

2025 Youth Delegate Designation of Beneficiary Insurance Policy

2025 Youth Tour Consent for Medical Treatment, Liability and Publicity Release Form

2025 NRECA Youth Leadership Council (YLC) Application

Part 1: School Information

Part 2: Extracurricular Activities

2025 NRECA Youth Leadership Council (YLC) Permission & Medical Release Form

This form is required if your child plans to apply for one of the YLC positions representing Virginia, Maryland, or Delaware.

2025 Electric Cooperative Youth Tour Health Form

2025 ELECTRIC COOPERATIVE YOUTH TOUR HEALTH FORM

PARTICIPANT INFORMATION

PARENT/LEGAL GUARDIAN CONTACT INFORMATION

ACKNOWLEDGMENTS

Outage Map

Legislative Map

Scholarships

Cooperative Living