Mind Masters Summit
Youth entering 6th-8th grades in August 2024 are invited to join us for a FREE workshop on Saturday, August 3 from 9:15am-2:30pm at The Skills Center. Parents are also invited to a session with distinguished psychologist, executive coach, and author Dr. Nekeshia Hammond from 9:45-10:30am. Our newest initiative, Mind Masters is a wellness workshop for rising middle school students focusing on mental and emotional health and wellness among all youth (not just those from a military background). Featuring a keynote address by nationally touring speaker Nate Evans Jr., along with breakout sessions with Frameworks of Tampa Bay, the goal of the event is to provide youth with the tools needed to navigate their emotions and mental health. Former Buccaneers player Ali Marpet will make a special appearance as well. Lunch and light snacks will be provided to all participants.
Youth's Name
*
First Name
Last Name
Youth's Grade for the 2024-25 school year
*
Please Select
6
7
8
Youth's Age (as of Aug. 1, 2024)
*
What school does the youth attend?
*
Youth Email Address, if applicable. (The JIA83 Foundation will copy parents on ALL communications sent to youth participants. Email communications may include opportunities for follow up virtual sessions with speakers, additional mental/emotional wellness information and activities, etc.)
example@example.com
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Re-Enter Parent/Guardian Email
*
example@example.com
Parent/Guardian Cell Phone
*
Format: (000) 000-0000.
Parent Guardian Work/Other Phone
Format: (000) 000-0000.
Parents of participants are invited to stay after registration for a parents-only session with Dr. Nekeshia Hammond from 9:45-10:30am. The session will focus on how parents can support emotional health in middle schoolers. Coffee and light breakfast will be provided.
Will the parent/guardian above attend the morning session for parents from 9:45-10:30am with Dr. Nekeshia Hammond?
*
Yes
No
We would love for all parents who wish to attend Dr. Hammond's session to receive an opportunity to do so. Please fill out the section below ONLY if another parent will attend the parents-only session as well.
Additional Parent/Guardian Attending Dr. Nekeshia Hammond's Session
First Name
Last Name
Parent/Guardian Email
example@example.com
All parents will receive a copy of Dr. Nekeshia Hammond's newest book "Mindset Training," a comprehensive roadmap to living a more balanced, fulfilled life. The book will be shipped to the address below after August 3.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Youth attendees will receive the opportunity to engage in an interactive workshop/therapeutic activity based on their interests. Please select a first and second choice below:
What is the youth participant's preferred option for the interactive workshop/therapeutic activity?
*
Please Select
Yoga and Mindfulness Session
Creative Expression Art Therapy
Animal (Dog) Therapy
Physical Movement (Exercise/Athletic Activity)
Photography
What is the youth participant's alternate choice for the interactive workshop/therapeutic activity?
*
Please Select
Yoga and Mindfulness Session
Creative Expression Art Therapy
Animal Therapy (Dogs)
Physical Movement (Exercise/Athletic Activity)
Photography
Does the participant have any medical conditions of which we should be aware?
*
Yes
No
If yes, please explain medical condition:
Does the participant have any food allergies:
*
Yes
No
If yes, please indicate food allergies:
At the conclusion of the summit your child will:
*
Get picked up by the parent/guardian listed above
Leave with another family attending the event
Get picked up by an adult other than the one listed above
Other
If your child will leave with another family attending the event, please put their name here:
If your child will get picked up by another adult besides the name listed above, please put their name here:
If you checked "Other", please include more detail here:
WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY AGREEMENT AND PHOTO/VIDEO RELEASE: In consideration of participation in the Jackson in Action 83 Foundation (JIA83) Mind Masters Wellness Workshop, and/or use of the property and facilities of The Skills Center, I agree, for minority participants under my care listed above, to the following: I agree to observe and obey all posted rules and warnings and any oral instructions provided at or by The Skills Center and Jackson in Action 83 Foundation, their agents, employees, representatives, officers and directors. I understand there are inherent risks associated with the above referenced activity, including physical injury or even death. I acknowledge and understand participation includes possible exposure to and illness from infectious diseases including, but not limited to, COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; I assume all risks and take full responsibility for any personal injury, property damage, or other loss to minority members of my family listed above and further release, discharge, and covenant not to sue The JIA83, The Skills Center, their employees, representatives and agents (“Releasees”) for all injury, damage, or loss, arising out of my, my family’s, or my minorities under my care, participation in the above referenced activity or use of the property and facilities of The Skills Center, whether caused or contributed to by myself, my family, Releasees, or other third parties. I further agree to defend and indemnify Releasees from any claims, causes of action, damages, judgments, costs and expenses, including attorneys’ fees, which may arise from my, my family’s or minorities under my care participation in the above event, presence upon the property or use of the facility. I, on my behalf and (if applicable) on behalf of any minor family member or participant listed above, give JIA83 Foundation the right to photograph, film and/or videotape me and (if applicable) any minor family member or participant listed above and/or to otherwise record our image and/or likeness and to use, publish, display, reproduce, copy and distribute our image and/or likeness, in all forms of media now known or later developed, including on the Internet, for promotional activities. I further understand that JIA83 shall not be responsible for unauthorized duplications/use of our image and/or likeness by third parties on the Internet or otherwise. I, on behalf of myself and all other releasees listed above, release JIA83 from any claims that may arise regarding the use of my image and/or likeness including any claims of defamation, invasion of privacy or infringement of moral rights, rights of publicity or copyright. I,on my behalf and on behalf of any minor family members or minorities in my care listed above, acknowledge that I have carefully read this agreement and fully understand the terms and that I am under no pressure to sign this agreement and that I have been given a reasonable opportunity to review this agreement before signing. I further acknowledge that I have been offered a full refund of any money paid by me if I choose not to sign this agreement.
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Submit
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