Parental/Guardian Consent form

Student Information

Student's First Name

Student's Last Name

Student's Birthdate

Does the student live in the same household with you?

Yes

No

Comments

Parent/Guardian Information

First Name

Last Name

Email Address

Cell Phone Number

Alternative Phone Number

Country

Street

City

Region

Postal Code

Parental/Guardian Agreement

Dual Enrolled Students do not qualify for college financial aid and payment of tuition. Additionally, the cost of books and transportation to and from York College is also the student's responsibility.

From time to time, photographs or video images may be taken at various program activities and those photos and images may be used by York College of Pennsylvania in promotional materials without compensation or further agreement.

I give my consent for my son/daughter to be enrolled at York College as a Dual Enrollment. I understand that my son’s/daughter’s progress will not be monitored by the College. I am aware that my son/daughter will have access to all Academic Student Services offered to the traditional college student. I understand that my son/daughter, the aforementioned minor, is enrolling in an environment where he/she may be exposed to a more diverse curriculum and culture. Finally, I understand and agree to the information contained in the student section of this form above. All tuition and fees from the college and any collection costs or legal fees if applicable are the responsibility of the student.

Parent/Guardian Name

Parent/Guardian Initials

Date