YBGB Workshop Facilitator Registration

Facilitator(s) Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Organization

Facilitator(s) Title/Occupation

E-mail*

Workshop Subject or Category*

Workshop Title:*

Workshop Description:*

0/100

Explain how your workshop will actively involve the kids and help them learn about starting and running a business? *

0/50

What age groups can your workshop be modified for?*

6-910-1213-16All 3 age groups

Can your workshop provide homework assignment?*

YesNoOther

Can you commit to the workshops t for each age group?*

YesNo

Do you have another workshop you would like to present?

YesNo

Workshop Subject or Category*

Workshop Title:*

Workshop Description:*

0/100

Explain how your workshop will actively involve the kids and help them learn about starting and running a business.*

0/50

What age groups can your workshop be modified for?*

6-910-1213-16All 3 age groups

Can your workshop provide homework assignment?*

YesNoOther

Can you commit to the workshops once every 6 months for each age group?*

YesNo

Do you have another workshop you would like to present?

YesNo

Workshop Subject or Category*

Workshop Title:*

Workshop Description:*

0/100

Explain how your workshop will actively involve the kids and help them learn about starting and running a business.*

0/50

What age groups can your workshop be modified for?*

6-910-1213-16All 3 age groups

Can your workshop provide homework assignment?*

YesNoOther

Can you commit to the workshops once every 6 months for each age group?*

YesNo

Audio Request

YesNo

Projector Request

YesNo

If you have special needs for your workshop, please specify and we will try to accommedate.

Would you / your organization be interested in participating in future YBGB Resource Fairs?*

Yes, please send me more information when availiable.Not at this time.

Permissions & Agreements

By submitting below, I agree to:

Conduct my presentation in a safe, respectful, and age-appropriate manner.
Grant Enriching Young Minds permission to photograph or video record my session and use photos or recordings for promotional purposes.
Hold harmless Enriching Young Minds, its staff, volunteers, and affiliates from any liability arising from my participation.

I hereby certify that all of the information provided by me in this Application (or in any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in these documents may (or will) be cause for the denial of acceptance as a mentor, or immediate removal as a mentor, regardless of the timing or circumstances of discovery.

Volunteer Workshop Facilitator Form