A parent or guardian of a High School Intern applicant under 18 years of age must complete the parental consent form.


Parental Consent

Parent/guardian should complete the following information






Student name


Parental Consent High School Intern

High School Intern Program Parental Consent Form


I/we hereby give our permission for the placement of our child in a work training program supervised and coordinated by Penn State Health St. Joseph. I/we understand that he/she will be at this assignment during hours specified by the school’s teacher-coordinator.

I/we further understand that our child will receive practical experience from this program, without compensation, for this training and we absolve and release all persons, corporations, and the school district from any and all obligations or liabilities which may arise as the result of my/our child’s placement in the program.

I/we hereby agree that our child is permitted work at the training station agreed to. I/we further understand and agree that if and when our child does not meet the requirements of the internship agreed to and the requirements of the school; the coordinator has the right to remove the child from the training station.

I/we further agree to communicate with the coordinator regarding any problems which may arise before we contact the employer/mentor, except in the case of an emergency.

Transportation: I/we agree that our child will be responsible for transportation to and from the location of the internship.

Publicity: In order to assist publicizing work-experience opportunities afforded by the school, we give permission to the school to use pictures of the aforementioned student, showing him/her engaged in on-the-job activities in the form of printed material, slides, videos, press releases, publicity displays, etc.

Information Release: I/we also grant permission to provide any request from potential employer information about school performance, conduct, attendance, health, and other information pertinent to employment. I/we recognize that the referring agent, the teacher-coordinator has the responsibility of clarifying for an employer the applicant’s strengths and weaknesses for the benefit of both the student and the employer.