MIGIZI Enrollment Form

MIGIZI Enrollment
MIGIZI uses this form for basic contact and demographic information. We also request that the parent/guardian completes our field trip and talent release form and a Release of Information form specific to your school district or education/employment status form if you are no longer in high school. These three items are required for enrollment.
Program*
Choose which program you wish to enroll in.
Student Name*

First NameLast Name
Home Phone
If applicable.
Student Mobile Phone Number*
Please enter a valid phone number.
Student Email*
example@example.com
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Birth Date*

MonthDayYear
Reservation/Tribal Affiliation(s)
If applicable.
Are you (the student) tribally enrolled?*
Which of the following best describes your (the student's) gender identity?*

FemaleMaleTwo-SpiritTransgenderAgenderBigenderGender-Non-Conforming (GNC)Do Not Wish to IdentifyOther
Which of the following best describes your (the student's) ethnicity?*

American Indian/Alaskan NativeAsian/Asian AmericanBlack/African AmericanHispanic/LatinoMiddle Eastern/North AfricanNative Hawaiian/Pacific IslanderWhite/CaucasianMultiracialOther
Dynamic Dropdowns
School*
Write in your school name if applicable. If not, input N/A.
Grade for 2023-2024 School Year*
Are you behind on any credits in school?

YesNo
Student ID
Write in your student ID if applicable.
Health Concerns*
Describe any health conditions you have that may affect your participation in programming, e.g. Allergies, asthma, mental or physical disability, etc. If nothing, input N/A
Food restrictions*
Describe any foods that you cannot consume. If nothing, input N/A
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relationship Legacy
Emergency Contact Relationship*
Academic Transcript - Please submit your most updated academic transcript but if you can't submit in an academic transcript, please submit your favorite meme

Cancelof
Where did you find out about MIGIZI or who told you about MIGIZI?*
Permission / Release Information
Grade
If applicable. If not, input N/A
Talent Release
I grant permission to MIGIZI Communications Inc. their successors and assignees to use my image and/or photographic likeness, comments, projects, or writings completed as part of MIGIZI programs in connection with any reproduction in print or digital form or for subsidiary (business) purposes.
Talent release terms

I agree to the above terms.
Student Signature*

Clear
Should be Empty:

MIGIZI Enrollment

Permission / Release Information

Talent Release