YAB Parental Consent Form

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YAB Parental Consent FormKateryna Turner2026-01-13T20:37:11-06:00

YAB Parent/Guardian Consent

The Youth Behavioral Health Advisory Board (YAB) is a youth-led leadership group serving middle and high school students across North Arkansas. Members participate in monthly meetings, help guide youth behavioral health programming, collaborate with schools, and lead wellness and mental-health awareness initiatives in their communities.

Participation is voluntary, youth-centered, and supported by *ABHIN staff, trained adult advisors using a trauma-informed, psychologically safe approach.

Student First Name *

Student Last Name *

Student School District *

Alpena

Bergman

Berryville

Cotter

Deer/Mount Judea

Eureka Springs

Flippin

Green Forest

Harrison

Jasper

Lead Hill

Marshall

Mountain Home

Norfork

Omaha

Ozark Mountain

Valley Springs

Yellville-Summit

Guardian First Name *

Guardian Last Name *

Guardian Email *

Guardian Phone Number *

Guardian's Relationship to Student *

Parent/Step Parent

Grandparent

Aunt/Uncle

Legal Guardian

Other

Guardian Preferred Method of Contact *

Call

Text

Participation Details *

I Agree

YAB members may participate in activities including but not limited to: - Monthly advisory board meetings (virtual) - Planning and supporting school-based behavioral health initiatives - Leadership training and mentorship - Community events, student groups, and youth-driven projects Participation will never involve clinical treatment or asking youth to disclose private mental-health information.

Participate in YAB meetings and activities. *

Yes

Attend community or school-based events supported by YAB. *

Yes

Participate in supervised virtual meetings via Zoom or similar platform. *

Yes

YAB occasionally shares program highlights on printed materials, social media, or presentations.

I give permission for my child's photo or first name to be used for program-related communications: *

Yes

Health & Safety *

Parent/Guardian Understanding *

By agreeing to this statement, I acknowledge that: Participation in the Youth Advisory Board is voluntary. My child will receive leadership and training opportunities, not clinical treatment. Adult mentors will provide trauma-informed, age-appropriate supervision. I may withdraw my child from the program at any time. I may contact ABHIN with questions or concerns at any time. * Who is ABHIN? Arkansas Behavioral Health Integration Network (ABHIN) is a nonprofit organization dedicated to integrating high-quality behavioral health care across the healthcare continuum to improve health outcomes for all Arkansans. ABHIN works collaboratively with providers, payors, health systems, schools, and community partners to strengthen access to effective, coordinated behavioral health services statewide. ABHIN is the recipient of the federal Youth Behavioral Health Career Pathways Grant, an initiative designed to introduce middle and high school students across Northern Arkansas to careers in behavioral health while creating sustainable career pipelines to help address the region’s critical mental health workforce shortage. Through this work, ABHIN provides mentorship, education, and leadership opportunities led by a highly qualified team of certified and licensed behavioral health professionals with extensive experience in trauma-informed, youth-centered practice. To learn more about ABHIN and its programs, visit www.abhinetwork.org or contact Co-Founder and CEO Kim Shuler, LCSW at kim.shuler@abhinetwork.org.

I agree to let my child participate in the Youth Behavioral Health Advisory Board. *

Yes

I have additional questions. Please reach out to me using my preferred method of contact.

Thank you for submitting your consent.

There was an error trying to submit your consent. Please try again later.

44 Kingshighway
Eureka Springs, AR, 72632
info@abhinetwork.com
(479) 871-3611

About A-ROUTE-Pathways

AROUTE-Pathways is a program that introduces youth across North Arkansas to rewarding careers in behavioral health.

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This material is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,199,990 with 100% percentage funded by HRSA/HHS and $0 amount and 0% percentage funded by nongovernment source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.

44 Kingshighway
Eureka Springs 72632
info@abhinetwork.com
(479) 871-3611