Permission Form

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Discover Healthcare

Summer Program

Session 1: June 26th –July 14th, 2023

Session 2: July 17th – August 4th, 2023


Parental Consent Form

(For students under 18 years of age)


Dear Parent/Guardian:

We are pleased that your son or daughter has applied to the: Discover Healthcare summer program. This program will give your child an opportunity to explore his or her career interests and learn about a wide range of healthcare career opportunities. Students will meet and observe healthcare professionals in action in their work settings, including nurses, radiology technologists, respiratory therapists, physical therapists, laboratory technologists and more.

The program is held at Einstein’s Medical Center- Philadelphia Campus at Old York and Tabor Roads. During the three weeks of the program, students will meet from 9 am to 1:30 pm.

If your child is admitted into the program, he or she will be required to get (free of charge) a health screening at LiveWell Employee Health. If your child is less than 18 years of age, a parent or legal guardian will be required to accompany them to LiveWell. We will send your child all the information and forms they need and will guide them through the process.

If you have any questions, please call Ellen F. Goldberg, at 215-456-6059 or email Ellen.Goldberg@jefferson.edu

We ask that you sign the statement of consent below and return it with your child’s application to the program.

I hereby give my teenager permission to participate in Einstein Healthcare Network’s three -week, Discover Healthcare Summer Program.

Name of Child:
Name of Parent /Guardian:
By checking this box, I am providing a digital authorization for my teenager to participate:
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