Manifest Academy Registration Form

Application

Manifest Academy Conference & Summit

www.ManifestAcademy.net

support@ManifestAcademy.net

404-755-3535 (office) 404-393-9381 (fax)

The Manifest Academy is an awesome generational changing program that will enhance College, Career, and Family Success for many young men. Manifest Academy promote s and empowers students to become outstanding leaders, by identifying and developing their unique talents and gifts. These gifts are the catalyst for understanding and actualizing their Assignment. Knowing your Assignment yields Peace, Power, and Purpose.

The Manifest Academy is committed to helping students to dominate in every area of interest. The program introduces students to fields and concert that are essential to holistic development. In addition, the program will help students to develop a Value, Vision, and Mission Statements that will serve as their blueprint for success.

Manifest Academy has two components: the Conference and the Summit. The Manifest Academy Conference is held every 2nd week in July, while the Manifest Academy Summit is held every 3rd week in December. Registration is limited, therefore we encourage families to registrar as soon as possible.

The Manifest Academy Conference will be held July 10 to 13, 2023. All activities will take place on the campus of Morehouse College 830 Westview Dr SW Atlanta, GA 30314. Student Housing will be at the Le Méridien Atlanta Perimeter Hotel 111 Perimeter Center W, Atlanta, GA 30346.

The Manifest Academy Summit will be held December 16 to 18, 2023. All activities will take place at Universal Studios in Orlando, FL 6000 Universal Blvd, Orlando, FL 32819. Student Housing will be at the Embassy Suites by Hilton Orlando International Drive Convention Center. 8978 International Drive Orlando, Florida, 32819.

This all-male monitoring program is designed for student’s 9th to 11th grade. The age range is 14 (minimum) to 17 (maximum). Students will be selected based on recommendation, grades, and essays. Please visit www.ManifestAcademy.net for more information.

Manifest Academy Conference & Summit

Permission / Waiver of Liability

Parent or Guardian Name*

First NameLast Name

, give permission for my child,*

First NameLast Name

permission to attend and participate in

Students are resposnsible for arriving at the disingated Manifest Academy location 2 hours before the starting time.

Additionally, I agree to waive my liability rights and hold Manifest Academy, the representatives of Manifest Academy and its agents harmless. I further agree to provide and use personal liability, and health insurance coverage during the above mentioned college tour.

By signing this form you have agreed to all of the payments and policies; and you are certifying that you are the parent or legal guardian of the applicant named above.

Medical Precautions/Restrictions

If a medical emergency should arise regarding my child, I hereby give permission to the official representative or representatives of Manifest Academy to select a physician and/or hospital for my child's care and to administer any emergency medical treatment that my child may require. I also give such medical personnel and or hospital my permission to treat my child at the request of representatives of Manifest Academy. I understand that Manifest Academy cannot assume responsibility for medical expenses for my child and I agree to bear such responsibility and pay any such expenses incurred with respect to such medical emergency. I release Manifest Academy and its representatives from any claim and/or liability or damages as a result of any illness or injury, or any property damage, which may be suffered by my child during scheduled activities. I also understand that the activities have an element of risk and that my child must listen carefully to all instructions and obey all rules.

Student Name*

First NameLast Name

Student Cell Number*

Please enter a valid phone number.

Student Email*

example@example.com

Age*

Grade*

Student GPA*

Student Test Scores (if taken)

Student School Name*

Student School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Shirt Size*

Only Adult Sizes Available

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Students' Date of Birth*

Date

Parent Name*

First NameLast Name

Parent Cell Number*

Please enter a valid phone number.

Parent Email*

example@example.com

Relationship to the Student*

Physician's Name

Medication taken daily

Dosages

Reason

Allergies (food, drugs, other)

Any other Information / Medical conditions we need to know for medical care

(i.e. diabetes, hypertension, asthma)

Upload Medical/ Insurance Card

Student Requirements

• High School Students (9th grade to 11th grade)

• Positive Mindset

• Complete Application Form (available online)  

• Statement of Purpose (300 words Max)  

• Community / Teacher Recommendation Statement  

• Last Report Card

• Application Fee

• Manifast Academy Fees will be required upon student acceptance

**Fees can be paid in foru installments**

Manifest Academy Conference in Atlanta, GA Deadline May 1, 2023

Fees & Requirements: $1195.00

Manifest Academy Summit in Orlando, FL Deadline October 1, 2023

Fees & Requirements: $895.00

Upload Statement of Purpose (Word document)

Community / School Recommendation (Word document)

Last Report Card (PDF)

Upload your Student Video (a problem in this world that disturbs you; what is you solution)

Code of Conduct

In addition to the curfew, the following rules are strictly enforced. Infractions of these rules may result in immediate dismissal from the program. In case of such a dismissal, your parents will be notified and, at the discretion of the director, you may be required to return home immediately at your own expense.

The schedule and itinerary will be followed as planned. No tardiness or absences unless required for Medical reasons. Students are expected to be mindful of schedules and time constraints in order to ensure that students are accounted for and on time at all group activities. Some alterations in the schedule can be expected; however, personal deviations will not be accommodated. Be prepared to be flexible

Students must be inside hotel rooms by 10:30 p.m. each evening. Students are not allowed to leave room after 10:30 p.m., and are expected to observe the quiet rules of the hotel, in respect for other hotel guests. Adults are expected to enforce curfew expectations as well as an atmosphere of quietness in the hotel.

Students must not engage in distracting behavior during group activities. This includes but is not limited to cell phone usage, text messaging conversations, personal sidebar conversations, or usage of personal electronic devices. (ear buds, air pods)

Students must comply with all group rules and standards which are announced verbally or in writing by Manifest Academy staff. Manifest Academy shall have complete discretion to terminate participation in the Academy and to send me home at adult and students own expense. Nobody who is sent home is entitled to any refund from Manifest Academy.

All logistics for each tour will be handled by Manifest Academy personnel only. This includes but is not limited to hotel lodging, food, transportation, and scheduling of venues.

Proper respect and consideration for others is expected at all times. Problems are to be resolved with open communication and goodwill. Anger, moodiness, envy, emotional manipulation, pettiness, and immature behavior are to be avoided at all times.

Students must accept responsibility for their conduct and judgment at all times. In addition they must accept responsibility for any financial obligations incurred.

Students will respect the property of others; they will not steal or take anything from the hotel room that does not belong to them.

No additional charges to the room should be made. No pay-per-view, long distance calling, or in-room food service should be charged to the hotel rooms

No use or possession of alcohol, controlled substance (drugs) or tobacco at any time. No swearing, cuss words, or any offensive language.

No writing graffiti on private property (bus, walls, bathroom stalls, etc.).

No water activities are allowed.

Prompt attendance is expected at all times for all activities.

Students should not leave the hotel or designated area without notification

All students must participate in group activities.

Students must demonstrate respect for all figures of authority.

All complaints with venues, hotels, and transportation should be addressed directly to and solely with Manifest Academy personnel.

Manifest Academy reserves the right to document in video, photo, or survey for promotional purposes in future trips.

By signing this form, you are stating that you are in agreement with the above statements

Student Signature*

Clear

Student Signature Date*

Date

Parent Signature*

Clear

Parent Signature Date*

Date

Application Fee*

Manifest Academy Conference Application Product Image

Manifest Academy Conference Application July 10 - 13, 2023 Atlanta, GA

$75.00 Quantity
Item subtotal:$0.00

Manifest Academy Summit Application Product Image

Manifest Academy Summit ApplicationDecember 16 - 19, 2023 Orlando, FL

$75.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

Fee Includes (Transportation, Housing, Tuition, Workbooks, Supplies, Snacks, Breakfast, Lunch, Dinner, T-shirts, Success Coaching, STEM Lab, Personal Development Seminars, Mentorship for Life)