Urban League of San Diego County (ULSDC) Project Ready Leadership Registration Form

Parent/Guardian
Guardian / Mother's Name*

First NameLast Name
Guardian / Mother's Email*
example@example.com
Guardian / Mother's Mobile Phone Number*
Please enter a valid phone number.
Guardian / Father's Name*

First NameLast Name
Guardian / Father's Email*
example@example.com
Guardian / Father's Mobile Phone Number*
Please enter a valid phone number.
I approve of my child participating in this program and assign and grant to National Urban League (NUL), the Urban League of San Diego County(ULSDC), its affiliates, its partners, the right and permission to use and publish the photographs / film / videotapes/electronic/likeness/representations and/or sound recordings made of me or my child at all activities and I release and hold harmless the parties listed above from any and all liability from such use and publications. I further authorize the editing, alteration, reproduction, copyright, exhibit, broadcast, electronic storage and distribution of said photographs / film / videotapes /electronic representations and/or sound recordings at the discretion of of the parties listed above and I waive any right to any compensation that I may have for any of the foregoing. I have read this statement and fully understand its terms and sign it freely and voluntarily.

YesNo
Signature (If you said yes above, and you are the authorized parent or guardian, please sign.)

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