Youth Referral/Parent Permission Form
REFERRING AGENCY INFORMATION:
The primary goal of our program is to provide confidential services and support for youth and young adults ages 12-24 who may be vulnerable to any form of domestic violence, sexual assault, sexual exploitation, or human trafficking because of challenging life experiences.
PROVIDE INFORMATION/INCREASE KNOWLEDGE OF:
Harassment and its effects
Provide information about survivor’s legal rights and resources
Community programs and referral options
EMOTIONAL SUPPORT AND SAFETY SERVICES:
Assistance writing an Order for Protection or Harassment Restraining Order
Assistance writing a Victim Impact Statement or working with County Attorney
Advocate to attend court hearings for support
Support with medical exam, law enforcement interview, or legal meetings and procedures
Provide tools to reduce self-blame and identify anxieties about situation
Create a plan to increase safety
Safe place to talk and share their story
Create healthy ways to process their reactions, thoughts and emotional expression and being aware of self-care options & health
Increase support system, including one-on-one support
Connecting with the Safe Harbor Regional Navigator for services related to sex trafficking and exploitation
Your child is being offered the opportunity to participate in youth programming though the Southwest Crisis Center. Some of the services may include personal advocacy, one on one education services, group therapy and services as well as access to resources and referrals and transportation. Topics covered within the programming may include healthy relationships, setting boundaries, self-esteem, empowerment, goal setting, safety with technology and relevant resources on health and safety.
Youth advocates at the Southwest Crisis Center successfully complete direct and specific training which includes the MN standard of 40 hours of sexual assault advocacy training, as well as continuing education on domestic violence, sexual exploitation of youth, crime victims’ rights and services and many other topics.
Please fill out and submit the information below, giving approval for your child to participate in the youth programming offered through the Southwest Crisis Center.
SWCC Youth Staff
I (parent/guardian entered above), give my child (youth entered above) permission to participate in youth programming at the SWCC.
Initial if you give permission to the Southwest Crisis Center staff to provide transportation as needed.