Participation and Registration Form

Blessed Foot Forward Participation & Registration Form

© Blessed Foot Forward Mentoring (BFFM) 501 (c) (3)
Your CHILD's Name

First NameLast Name
Parent/Legal Guardians Name

First NameLast Name
Address
E-mail
example@example.com
Phone Number

Area CodePhone Number
Child's Date of Birth

MonthDayYear
Gender
Grade Level
IMPORANT! We believe in our program, and we believe in our kids. Do you agree to share our program to ALL who will listen?
Registering for:
(*) Denotes confirmed Blessed Foot Forward Mentoring (BFFM) 501 (c) (3)
Please detail your child(s) Current emotional status?
Please provide a short blurb about your child(s) experience with peers, family dynamics, or any additional information you believe would be valuable to mentors?
What is your expectation of this program?
Do you have any concerns for your child at this time?
If yes, please tell us which one
Does your child have any health concerns or food allergies?
If yes, please tell us which one
I release the organizers from any liabilities, loss, damage, and fees during theprogram or while on the premise.

I indemnify and hold them harmless from any injuries, demands, or deaththat may be sustained by my child.

I accept the risks that are associated with my child when we/I decided toallow him/her to participate.

I authorize the organizers to take photos and videos of my child during theprogram and while on the premise.

I allow them to use this for educational,advertising, and marketing purposes provided that they value our privacy with respect and will not associate it with unpleasant situations.

I understand & acknowledge that I will NOT be notificied of ANY questions, comments or contributions to discussions made by my child UNLESS such comments are a cause for concern to the safety of the child or another.

I am the parent/legal guardian of the participant, I am fully competent and I am above 18 years of age.

I have read and understand the waiver agreement above and by signing thisdocument, I hereby agree and confirm that I will abide by it.
Signature
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Blessed Foot Forward Participation & Registration Form