Language
  • English (US)
  • Español

  •  -
  • Browse Files
    Cancelof
  • Browse Files
    Cancelof

  • Parent/Guardian Information

  •  -

  • School Information

  • Photo/video release

  • Clear
  •  - -
    Pick a Date
  • Clear
  •  - -
    Pick a Date
  • Clear

  • Student Information

  • Safety Form

    Participant Health Form Emergency Medical Consent Assumption of Risk Code of Conduct Infraction Penalties

  • Parent/guardian with residential placement and/or decision-making authority in the event of illness or injury:
  •  -
  • Clear

  • Second parent/guardian with legal responsibility/authority to be contacted in case of illness or injury:
  •  -

  • Browse Files
    Cancelof

  • Medication is any substance a person takes to maintain and/or improve their health. This includes all prescription medication, as well as all over-the-counter drugs that are potentially hazardous if misused (ex. Tylenol, aspirin, cough medicine, cold tablets, vitamins & natural remedies). All medications must be in their original containers. Prescriptions must have the child’s name and how the medication should be given printed on the prescription container. Please send only those medications that are necessary. Participants are required to turn medications into staff upon arrival.
  • Browse Files
    Cancelof

  • This health history is correct and accurately reflects the health status of the participant to whom it pertains. The person described has permission to participate in all program activities except as set forth by me and/or an examining physician. If you fail to advise Life Enrichment Group of a medical condition, risks to your child may increase. I understand the information on this form will be shared on a “need to know” basis with L.E.G staff and volunteers. I give permission to photocopy this form. In addition, the health care provider has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

  • I voluntarily sign this authorization in consideration for permission for my child(ren) to participate in the Life Enrichment Group and Know to Grow College Tours. I have read it, and I understand its content and significance. 

      *    Pick a Date*   
    Signature of Parent/Guardian (For participant less than 18 years of age)

    *   Pick a Date*   
    Signature of Participant (For participant 18 years of age or older)

    Parent/Guardians: Keep a copy for your records. 

  • Emergency Medical Consent

    In an emergency requiring medical attention or a situation reasonably believed to be an emergency by Life Enrichment Group (L.E.G) authorized agents including event staff; I authorize L.E.G and its authorized agents to obtain emergency medical care for my child. I will be responsible for any expenses incurred in so doing including but not limited to care by health care professionals, hospital care, and ambulance or other services. In addition, the health care provider has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status. NOTE: Minors may consent to certain services in Washington. I hold harmless and agree to indemnify Life Enrichment Group, its authorized agents and employees and the event staff from decisions to seek emergency treatment.

  • HEALTH CARE PROVIDERS:
  •  -

  • Assumption of Risk

    I am the parent or guardian of the child (minor under the age of eighteen, or other person legally incompetent to contract, whose name is set forth on this form). I understand that there are risks in participating in recreational activities and educational workshops during this particular L.E.G activity. Risks in participating in L.E.G activities, including touring campus laboratories, participating in recreation activities, workshops, and general tourist activities, include but are not limited to: temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, orthopedic damage, head, neck or spinal injuries, eye damage, burns or death. I also recognize that these are both foreseeable and unforeseeable risks of injury or death that L.E.G cannot specifically anticipate and list here. Further, I recognize that the actions of other participants in the activity may cause harm or loss to my child or property.

  • PARENT OR GUARDIANS’S RELEASE OF CLAIMS AND LIABILITY

    I release, the state of Washington and Life Enrichment Group officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses to person or property, which I may sustain and/or sustain as a result of death or injury of my child, as a result of or connected with participation in the above event. My child’s participation includes, but is not limited to, travel to and from the event in a private or public vehicle, any activity connected with the event itself, and use of state equipment or facilities for the event whether on or off L.E.G property. I have carefully read this document, understand its contents and am fully informed about this program and circumstances. I am aware that this document is a contract with LEG and the program sponsors. I sign it freely and voluntarily.
  • Clear
  •  - -
    Pick a Date
  • Clear
  •  - -
    Pick a Date

  • Infraction Penalties

    Conduct not in keeping with Life Enrichment Group standards will not be tolerated. Violation of items listed above will result in consequences to the participant. Law enforcement may be called and illegal behaviors may result in citations or arrest. Consequences may include removal, at the individuals/family’s expense and without refund, from participation in the event; restitution or repayment of damages; sanctions on participation in future L.E.G events; forfeiture of financial support for this event; removal from positions held in L.E.G; and/or loss of status as a member in good standing, and the privileges associated with that good member status.

  • CODE OF CONDUCT
    (Please keep this page for your records; you do not need to turn in this page)


    The Life Enrichment Group Code of Conduct is to ensure the safety of all participants and to encourage conduct and behavior that will result in each participant receiving the full benefit of enjoyment and educational experience from this event. Participants are asked to consider both their underlying attitudes and effects of their behavior in representing themselves, their communities, and the Life Enrichment Group program.


    Program participants and chaperones are expected to abide by the stated rules for this event:


    • Fully participate in all scheduled activities. Inform your chaperone if you are ill.
    • Conduct yourself in a courteous manner, being respectful to all speakers, adults, roommates, and other participants. Use appropriate language, exhibit good sportsmanship, and act as a positive role model. Turn cell phones off or on silent during scheduled activities (no texting), workshops and speakers.
    • Be in your own rooms, observing the ‘lights out’ time noted on the schedule, and remain in your room/dorm all night.
    • Display of overly affectionate attention between participants is prohibited.
    • Do not tamper with or damage room furnishing, furniture, equipment, etc. Room occupants are responsible for any damage or misconduct. Falsely pulling a fire alarm is a crime.
    • Participants may not drive a car after their arrival at the event.
    • Abide by the dress code; it was developed to prevent participants from becoming offended or uncomfortable during their stay. If you choose to dress inappropriately, you will be asked to change. By planning ahead and packing appropriately, you will save yourself the inconvenience of changing your attire to ensure that you are contributing to a pleasant conference atmosphere.


    The following dress code will be enforced for all individuals attending the conference, including chaperones:


    1. Clothing: all clothing shall be neat, clean, acceptable in repair and appearance, and shall be worn within the bounds of decency and good taste as appropriate for L.E.G events.
    2. Professional attire is strongly encouraged at this event at all the meetings.
    3. Articles of clothing which display profanity, products, or slogans which promote tobacco, alcohol, drugs, sex, or advertise gang symbols or affiliation are prohibited.
    4. Items of clothing which expose bare midriffs, bare chests, undergarments, or that are see-through are prohibited. Halter tops, tube tops, and spaghetti straps are not appropriate.


    The following behaviors will not be tolerated:


    • The possession or use of alcohol or illegal drugs, tobacco products, stolen goods, weapons, and fireworks.
    • Females in male rooms, males in female rooms.
    • Sexual, physical, or verbal abuse. Pornography materials of any kind.
    • Disrespect or negative attitudes of any kind will NOT BE TOLERATED.

  • Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

  • For Youth

    I have read the Code of Conduct and agree to abide by it.

  • *   Pick a Date*   

  • I understand that I am responsible for my child’s behavior. I give permission to the staff in charge to administer the code. I understand that if my child is sent home, it will be my responsibility and at my own expense, and that the activity
    fee will not be returned.

  • I, * have read the Code of Conduct.   

    *   Pick a Date      

  • I understand that I am responsible for my child’s behavior and will be responsible for all costs and expenses should my student not adhere to the code of conduct. I give permission to the staff in charge to administer the code. I understand what is being asked and expected of my student. I, * have read the Code of Conduct.            

  • By signing below, you are agreeing to pay the $200 nonrefundable deposit to secure your spot for one of the Know to Grow College Tour Experiences. The total cost of the HBCU College Tour is $2,000 and the total cost of the Cali tour is $1,350. Participation in L.E.G.'s annual fundraiser is required in order to attend a Know to Grow College Tour Experience. Monthly payments will be scheduled and set with the L.E.G. team through PayPal. After you submit this application, you will receive an invoice to pay your nonrefundable deposit via the email we have on file. Please ensure the email you add on this form is accurate. Thank you and we look forward to you joining us for the Know to Grow progam!

  • Clear
  • Should be Empty: