2024 Flourish & Grow Summer Youth Workshop Registration Form

Flourish & Grow Summer Youth Workshop Registration Form
On August 24, 2024, Positively Caviar, Inc. will host an immersive mental wellness workshop experience titled "Flourish & Grow" at the Under Armour (UA) House at Fayette to equip middle school-aged youth with experiential tools to increase well-being and disrupt mental health stigmas.

Please fill out the form below to register.

For more information, please visit: www.positivelycaviar.com/flourish-grow
Participants Name*

First NameLast Name
Participants Age*
Participants Date of Birth*

MonthDayYear
Date
T-Shirt Size**
*Unisex Adult size
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School*
Grade Level*
Please list all Allergies Below:
Does the participant have any medical conditions that we should be aware of?
How did you hear about this event?*
Parent/Guardian/Emergency Contact Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Phone Number*
Please enter a valid phone number.
Acknowledgment
I agree to follow the guidelines, rules, and policies of the organization. If a chaperone or driver is needed, I'll do that. I allow my child to be photographed or be part of the video that will be used for marketing, promotion, and advertisements. The repeated offense of the youth may result in suspension or expulsion. Parent/Guardian registered in this form has legal custody over the child. For medical emergencies, I allow the medical team of this organization to take care of my child. I release this organization from any and all liability from accident or injury to the child during the organization related events.
Photo Release Consent Statement: I, as the parent and or legal guardian grant Positively Caviar Inc. permission to use any and all photos taken for any legal use, but not limited to: publicity, copyright purposes, illustration, advertising, and web content.*

I agree to the statement aboveI would like to opt my child out
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Flourish & Grow Summer Youth Workshop Registration Form

Parent/Guardian/Emergency Contact Information

Acknowledgment