TOP Club Registration

Arizona Youth Partnership (AZYP) has received a grant from the Arizona Department of Health Services (ADHS) to deliver the Wyman  Teen Outreach Program® curriculum. During the time your child will spend in the program, they will explore their own growth and  development. This unique program will involve your child in discussions regarding communication, healthy relationships, goals &  peer pressure and allow him/her to make a difference in the community through service learning projects. The program promotes  progress in school and avoidance of behaviors which may hinder your child’s opportunities for successful growth and achievement;  overall the program aims to address and prevent teen pregnancy. All program information has been shared with and approved for delivery by the school/agency administrators. The ADHS funding provided for this program also includes a pre and post evaluation which requires parental consent. There are two separate evaluation administered; one for ADHS and the other Wyman. We require  consent for each of these evaluations.

I, indicated above , am the Parent or Legal Guardian of the child named above who is to participate in programs provided by AZYP during the current school year. I am willingly allowing the child mentioned above to participate in all aspects of the program under the supervision of AZYP staff.  

I give my consent for my child to complete surveys during their TOP® Club  participation. Wyman Center, Inc. operates a secure environment to collect and store information from student participants in its Teen  Outreach Program® . The online system also stores information about the TOP® services each student received.  Wyman collects the following types of information directly from TOP® participants through online surveys: 

-Opinions about their experience in TOP®

-Demographics: Ethnicity/race, gender, age, grade level, parents’ education level 

-Social and emotional skills, sense of self, connections with others -Grades in school, skipped classes, suspensions, graduation and schooling plans 

I understand Wyman and AZYP uses the participants’ responses to improve the Teen Outreach Program® . I understand that survey and data collection is voluntary and that my child may choose not to participate at any point in the process without risk of losing TOP® services. I am also aware my child will not be required to disclose more information than is reasonably necessary to participate in Teen Outreach Program® as a condition of participation. I am aware that survey results for the entire TOP group may be used to market Teen Outreach Program® to increase awareness and funding; results may also be used for publications or conference presentations. However, your child’s identifying information will not be disclosed except in the case where online access is unavailable and therefore paper survey data is entered by a third party or employee under a strict non-disclosure of confidential information agreement. I also understand that the associated risks for my child to participate in this survey are minimal and will not exceed any discomfort that may be found in any daily life situations when answering routine survey questions.

For questions concerning program and/or ADHS Evaluation: Kelley Coronado, Director of Youth Wellness, 520-744-9595,  Kelley@azyp.org