FREE to Join. Sat. 9/7 11:30am
High School Jr & Sr Only
Teen Name
*
First Name
Last Name
Current Grade 2024-2025
*
2nd Teen Name
First Name
Last Name
Current Grade 2024-2025
Parent Name
*
First Name
Last Name
Parent Phone Number
*
-
Area Code
Phone Number
Parent E-mail
*
City of Residence
By joining, I hereby authorize Care for Me Youth Initiatives/ Shekita Jackson to utilize all information contained in this application for program purposes. I release all such persons or entities from all liability. I agree to photos and videos taken of the program which will contain all adults and children listed in this registration, I agree that photos and video can be used for funding purposes. I understand that this personal information will be held confidential by Shekita Jackson/Care for Me Youth Initiatives/volunteers & staff.
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