Thrivers Club Registration Form

Thrivers Club Registration Form
DESCRIPTION:

Members between the ages of 6 and 11 are placed on the Kids Thrivers Club, while those between 12 and 19 belong to the Youth Thrivers Club

The primary program of the Youth Thrivers Club is the "Youth Leadership Forum" a hybrid monthly meeting for and by young people, that combines various learning and engagement forms as well as peer-to-peer networking aimed at nurturing leadership and enhancing a social network among our youth. The purpose is to equip young black individuals with leaderships and prepare them for the future.

The primary program of the Kids Thrivers Club is the "Kids Book & Story-Telling Forum" designed for children to immerse themselves in the world of storytelling and literature, featuring interactions with authors and engaging storytelling sessions. The approach involves Interactive workshops and dramatized presentations to promote a love for reading in a family-oriented community setting.

In addition to these, Thrive4Blacks has an array of other programs available to both categories of Thrivers Club members, including Culture and Heritage programs, Summer Skills Workshops, Financial Literacy Programs etc.
Registrants Information

Provide information about Youth or Kids joining the Thrivers Club. (Youth that are 18 years and older, should complete separate forms individually. Up to four kids and youth that are below 18 can be accommodated in one form).
What best describes you?
Name

First NameLast Name
Your Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Unique Client Identifier #
Preferred Language
City of Residence
- Number of Registrants
- 1. Registrant #1 (Full Name)
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Gender
- Unique Client Identifier #
- Preferred Language
- 2. Registrant #2 (Full Name)
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Gender
- Unique Client Identifier #
- Preferred Language
- 3. Registrant #3 (Full Name)
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Gender
- Unique Client Identifier #
- Preferred Language
- 4. Registrant #4 (Full Name)
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Gender
- Unique Client Identifier #
- Preferred Language
- Parents/Guardians Information
  
  Provide information about Parents/Guardians in the order of contacting priority
- Full Name (1st)
  
  First NameLast Name
- E-mail
  example@example.com
- Phone
  
  Area CodePhone Number
- Relationship to Registrants
- Full Name (2nd)
  
  First NameLast Name
- E-mail
  example@example.com
- Phone
  
  Area CodePhone Number
- Relationship to Registrants
- Parents/Guardians Consent
  
  Provide required consents
- LIABILITY RELEASE: I, the undersigned do hereby give permission for my child(ren) to attend and participate in any Thrive-4-Blacks' Thrivers Club activities and indoor/outdoor programs. I hereby voluntarily release and discharge Thrive-4-Blacks, its officers, directors, volunteers and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities.
- PHOTO RELEASE: I agree that Thrive-4-Blacks may photograph and record the likeness and activities of my child(ren) during Thrivers Club activities and programs. I also grant Thrive-4-Blacks the permission to modify, use and publish in any medium and for any purpose.
- CONFIRMATION AND SIGNATURE: The information I've given in this form is complete and accurate. I hereby execute this document by signing in the box below, and I confirm that I have fully informed myself of the contents of this Consent and Release Form before doing so. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
  Name of Parent/Guardian Signing
- Signature
- PHOTO RELEASE: I agree that Thrive-4-Blacks may photograph and record my likeness and activities during Thrivers Club activities and programs. I also grant Thrive-4-Blacks the permission to modify, use and publish in any medium and for any purpose.
- CONFIRMATION AND SIGNATURE: The information I've given in this form is complete and accurate. I hereby execute this document by signing in the box below, and I confirm that I have fully informed myself of the contents of this Consent and Release Form before doing so.
  Enter your name here
- Signature
- Should be Empty:

Thrivers Club Registration Form

Registrants Information

Parents/Guardians Information

Parents/Guardians Consent