iSparkle2 LeadHERship

Diamond LeadHERship Registration Form

Fill out the form carefully
Daughter's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Daughter's Mobile Number
T-Shirt Size*
Grade*
School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Name*

First NameLast Name
Parent E-mail*
example@example.com
Parent Mobile Number*
Any Medical or Dietary Restrictions?*
Liability Waiver:

In consideration of iSparkle2 allowing the above to participate in iSparkle2 activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless iSparkle2, Inc, its directors, employees, volunteers and agents from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child while involved in iSparkle2, Inc events. Furthermore, we (I) [and on behalf of our (my) minor child(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in activities involved therein.
Signature*

Clear
Medical Treatment Permission:

We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.
Signature*

Clear
I Certify:

I have custody of Participant or am the Legal Guardian of Participant by court order. I am aware that this agreement includes a release and waiver of liability, an assumption of risk, and an agreement to indemnify the releasees.
Signature*

Clear
I Consent:

I consent to allow photography of my child during all iSparkle2 events and use for marking/promotional activities.
Signature*

Clear
Additional Comments
**Special events may require a participation fee.** We expect each girl along with the help of parents to participate in fundraising events to help support the future of the program. There will be at least two fundraisers per season. All donations and monetary sponsorships given in support of the iSparkle2 organization are used to facilitate program operations. The iSparkle2 mentoring and Diamond LeadHERship program is a non-profit organization with a 501(c)(3) status. Therefore, donations are tax deductible .
By submitting this application you confirm that you understand and accept the terms of this application and our refund policy (non-refundable). .

iSparkle2 LeadHERship Program Registration Fee

$25.00

Enter coupon

Total

$0.00

Should be Empty:

Diamond LeadHERship Registration Form

Liability Waiver:

Medical Treatment Permission:

I Certify:

I Consent:

By submitting this application you confirm that you understand and accept the terms of this application and our refund policy (non-refundable). .