Youth In Government Day Participant & Parent Waiver Fall 2025

Thank you for your interest in attending this year's Youth in Government Day on Tuesday, October 21,2025! During this event, participants will attend a panel discussion about local government and it's functions and future career opportunities, tour of the Douglass Community Center, and eat lunch with their voting district representatives. This year's program is for current Juniors and Seniors attending school in Loudoun County, Virginia.

Registration opens on Tuesday, September 2, 2025 and will close on Wednesday, October 1, 2025 at 9 AM.

Details about Youth in Government Day

Day of event: Tuesday, October 21, 2025

Time: 11:30 AM - 6 PM

Location: Douglass Community Center 407 E Market St, Leesburg, VA 20176 and Loudoun County Government Center 1 Harrison St SE, Leesburg, VA 20175

Please note that school is in session on Tuesday, October 21, 2025. To be accepted, you must be committed to attending Youth in Government Day. Please note that we will be taking attendance on Youth in Government Day. Your school will be notified of your absence if you don't show up. There are only a limited number of spaces available for this event. Please do not fill out the application unless you are sure that you can attend.

Additionally, please note that transportation will not be provided for this program. You will be required to provide your own transportation to get to either Douglass Community Center or the student driver parking lot - Pennington Lot in Leesburg, VA. We will be providing transportation to and from the Douglass Community Center and the Government Center during program hours.

In order to take advantage of this unique learning experience, you and your parents/guardian will need to complete the Student Application below. Applications will be accepted no later than October 1, 2025 by 9 AM. We will only be accepting three applicants from each school. A waitlist will be created if we exceed slots.

Tentative Schedule*

*subject to change*

11:30 AM - 12:00 PM Check in and registration at Douglass Communtiy Center
12:00 PM - 12:45 Lunch
12:45 PM - 1:30 PM Keynote Speaker
1:30 PM - 2:00 PM Tour of Douglass Community Center
2:00 PM - 3:15 PM Panel Activity
3:15 PM - 3:45 PM Transported to Loudoun County Government Center
4:00 PM - 6:00 PM Loudoun County Board of Supervisor Meeting
6 PM - Dismissal

For more information about other Teen Services programs please click here

For questions please review the Youth in Government Day Student Information Packet

Student Section

Full Name*

First NameLast Name

Date of Birth*

Date

Student Email*

Please make you put one that you check the most often.

Student Phone Number*

Please enter a valid phone number.

Which high school do you attend? *

What is your home address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What grade are you in?*

Junior (11th grade)Senior (12th grade)

What is your voting district? If you do not know your voting district, please visit the address below so we can ensure you are matched with the Board of Supervisors member that represents you.*

NOTE: Please double check your district via the web tool below. Just because you live in Sterling, Ashburn, or Leesburg does not guarantee that is your voting district!

Click Here to check for your voting district

Or if the link doesn't work for Voting District Lookup please copy and paste the link below:
https://www.loudoun.gov/index.aspx?NID=2782

Why are you interested in attending Youth in Government Day? *

Please submit no more than three sentences and do not use AI to assist you.

In what ways are you interested in local government and the jobs it offers?*

Please submit no more than three sentences and do not use AI to assist you.

Is there anything else you would like for us to know? *

Ex. Identified medical, personal care, or special needs (developmental, physical, emotional, or learning including but not limited to medications, dietary restrictions, or allergies.)

Parent/Guardian Section

Students who are 18+ still must have their parent/guardian complete this section due to LCPS attendance reporting.

Parent/Guardian Full Name*

First NameLast Name

Parent/Guardian Phone Number*

Please enter a valid phone number.

Parent/Guardian Email*

example@example.com

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.

Parent/Guardian Email

example@example.com

Emergency Contacts

Note: if Parents/Guardians and Emergency Contacts are unable to be reached PRCS must call VA Child Protective Services (CPS) in some emergency cases. Local emergency contacts are preferred, neighbors, family friends, etc. Out of town extended family will also be accepted.

Non-parent/guardian emergency contact # 1*

First NameLast Name

Non-parent/guardian emergency contact # 1*

Please enter a valid phone number.

Non-parent/guardian emergency contact # 2*

First NameLast Name

Student's Doctor or Healthcare Provider Information*

First NameLast Name

Student's Doctor or Healthcare Provider Phone Number*

Please enter a valid phone number.

The nature and scope of the activity listed above have been fully explained to me by the Parks, Recreation, and Community Services Staff and I understand that there may be risks and dangers associated with this activity. I also understand that each participant has the responsibility to exercise due care in the performance of the activity for their own safety and of the other participants and will abide by the safety rules and regulations established for the activity.

In consideration of the Participant being permitted to enroll and partake in this activity, I agree to assume all risks to my (child's) person or property, including transportation, incidental to such participation. I do hereby waive, release, absolve, indemnify and agree to hold harmless, the County of Loudoun, the Loudoun County Department of Parks, Recreation, and Community Services, and any Employees or Volunteers thereof, against any injury to person or property arising out of this registration.

By writing my full legal name, I give permission for the Loudoun County Parks, Recreation, and Community Services staff to obtain medical treatment for the above participant in the event of illness or injury if I cannot be contacted.

For further information please see the Youth in Government Day document packet above.

Student Signature*

Parent/Guardian Signature*

Date*

Date

Youth In Government Day Participant & Parent Waiver 2025