Permission Form

Permission Slip/Code of Conduct/Expectations

______ High School is excited to open "Senior-Youth Bridge", a pen pal and /or virtual visits connection between seniors and youth. Students gain the perspectives of their elders. Senior citizens enjoy sharing time with the youth. Communication can begin with letters from students which are brought to senior centers and hospitals. After sharing an introduction, some letters may ask questions like "How would you describe your life story? or What life advice do you have? Have you always felt that way or has your perspective changed? What has affected the perspective you now have?" Follow up communication can be in the form of letters and/or virtual visits on zoom or facetime. Any seniors who wish to meet virtually (either with or without a pen pal correspondence) can select virtual visit time slots from a calendar (see www.senioryouthbridge.com)

Code of Conduct/Expectations


  1. Polite and respectful language will be used at all times

  2. Students will demonstrate interest by being attentive and respectful.

  3. Initial student letters are positive, following the guidelines at least roughly

  4. Attention will be paid to sufficient volume of virtual visit microphone and speaking, and background noise minimized as much as possible. Student will try to speak clearly.

  5. School appropriate dress is required during virtual visits

  6. Virtual visits will not be recorded unless given written approval by Advisor.

  7. Gmail passwords and forwarding settings will only be changed at request of Advisor

  8. Students will make their best effort to attend all scheduled virtual visits. If rescheduling is necessary, the student will email senior her need to reschedule as early as possible. (Reminder: Students indicate maximum number of virtual visits in advance)

  9. Students will reply to all senior citizen emails within 2 days. (Sabina will be notified by email if communications become excessive.)

  10. Students will participate in SYB for at least one semester.


I agree to abide by the above Code of Conduct/Expectations

Student Name (PRINT) ___________________________ _______________________________________________

Signature ____________________________________________  Date: ________________


As parent/guardian, I give permission for _________________________________________________ to participate in Zoom, Google Meet, and Facetime “virtual visits” scheduled by seniors on Senior-Youth Bridge.  Parent/Guardian Name (PRINT) ___________________________ ___________________________

Signature ____________________________________________  Date: ________________


Emails from parents/guardians are accepted as digital signatures.