Registration Form
Join us for Dream to Lead: Empowering Tomorrow’s Leaders, on January 18, 2025 from 10am to 3pm, a program dedicated to middle school students, inspired by the legacy of Dr. Martin Luther King Jr. Hosted by The Legal Kid Foundation in partnership with LexisNexis, this unique experience blends advocacy, education, and inspiration.Through interactive workshops and hands-on activities, middle school students will explore leadership principles, understand the foundations of justice and equality, and engage in meaningful discussions on how they can be catalysts for change in their communities.
Dear Parent/Guardian:
Participant Name:
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth:
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Grade:
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Allergies/Medical Conditions:
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Medication Necessary During Program Duration:
Parent/Guardian Name:
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First Name
Last Name
Parent/Guardian Phone Number
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Please enter a valid phone number.
Parent/Guardian Email
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example@example.com
Permission and Consent: I, the undersigned, hereby grant permission for my child to participate in Dream to Lead: Empowering Tomorrow's Future Leaders. I understand that the program may involve educational activities, tours, and presentations related to the legal field.
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Name
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Parent(s)/Guardian(s) First Name
Parent(s)/Guardian(s) Last Name
Medical Information: In case of a medical emergency, I authorize the program organizers to seek medical attention for my child. I have provided information regarding any allergies or medical conditions that may affect my child's participation.
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Name:
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Print: Parent(s)/Guardian(s) First Name
Print: Parent(s)/Guardian(s) Last Name
Photography and Media Release: I grant permission for The Legal Kid Foundation to photograph, videotape, or otherwise record my child during the program. I understand that these materials may be used for promotional and educational purposes.
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I Agree
Do Not Agree
Signature of Parent or Legal Guardian
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Name:
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Print: Parent(s)/Guardian(s) First Name
Print: Parent(s)/Guardian(s) Last Name
Release of Liability:
I release The Legal Kid Foundation, and their respective staff and volunteers from any liability arising from my child's participation in the program.
Signature
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Name:
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Print: Parent(s)/Guardian(s) First Name
Print: Parent(s)/Guardian(s) Last Name
Emergency Contact:
In the event that I cannot be reached in an emergency, I authorize the program organizers to contact the following person:
EMERGENCY CONTACT INFORMATION
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Phone Type
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Mobile
Home
Parent(s)/Guardian(s) Email Address(es)
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example@example.com
Best Email address(es) to reach Parent(s)/ Guardian(s)
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example@example.com
Please indicate other students associated with this student.
Submit
Should be Empty: