2027 Washington Youth Tour Parent Permission Survey

A Leadership Experience

Once a year, local high school students are selected by Sumter EMC to represent our cooperative and state as delegates on the Washington Youth Tour. This top-notch leadership experience and tour of Washington, D.C. includes meetings with state and national leaders, leadership training, and visits to all the major sights. Participants join over 1,500 other students from around the nation—all expenses paid—for one incredible week in our nation's capital. It’s truly a trip of a lifetime.

The competition is open to all Sophomores, Juniors, and Seniors who will be 16 Years Old by the first day of the 2027 trip (June 17, 2027) and live in or attend a school in Chattahoochee, Lee, Marion, Schley, Stewart, Sumter, Terrell, or Webster County. Students not residing in or attending a school in the above counties are eligible if their parents are members of Sumter EMC and live within the cooperative's service area. The cooperative's service area is Marion, Schley, Sumter, Webster, Dougherty, Lee, Randolph, Terrell, Chattahoochee, Quitman, and Stewart counties.

This trip takes many students out of their comfort zone. We want to make sure we select four students who are willing to leave their comfort zone and travel to Washington D.C. with Georgia EMC chaperones and over 100 other delegates chosen by cooperatives from across the state.

Please complete the information below.

Parent/Guardian Name(Required.)

First Name

Last Name

Parent/Guardian Contact(Required.)

Cell Phone

Work Phone

Employer

Emergency Contact (other than parent)(Required.)

Full Name

Cell Phone

Student Name(Required.)

Preferred Name

First Name

Middle Name

Last Name

Student Address(Required.)

Street Address

City

State

ZIP Code

Student Gender(Required.)

Student Date of Birth(Required.)

Birthday - Must be 16 by June 17, 2027

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

School Name(Required.)

Student Grade (2026-27 Academic Year)(Required.)

Name four characteristics that best describe your student.(Required.)

Has your student flown before?(Required.)

Yes

Has your student ever taken a trip of this nature without parents or family members?(Required.)

Yes

Does your student have any medical conditions that would need to be known by the coordinators of this trip?(Required.)

Yes

If yes, please provide the information.

I, parent or guardian of the student applicant listed above, acknowledge that he/she has applied for the Sumter EMC Washington Youth Tour. This trip will begin on June 17, 2027 at 8 AM and will end on June 24, 2027. This will be an all expense paid trip by Sumter EMC, so I will ensure that my student will devote their full attention to this trip during the above dates and at the given time.

l give my consent for him/her to participate and understand that this participation involves travel within the state of Georgia and a flight to and from Washington D.C.

I hereby grant permission to Sumter EMC to use photographs, likenesses, and/or videotape images of my/our son/daughter in newspapers, magazines, newsletters, videotapes, radio/television broadcasts, and/or Internet Web sites (along with his/her name) for publicity purposes related to this activity.

ELECTRONIC SIGNATURE ACKNOWLEDGEMENT AND CONSENT FORM
I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. To complete and accept this form, type your full name in the box below.(Required.)

Please enter the date you have completed this consent form.(Required.)

Date of Completion