Student Ambassador Registration Form
Join us for free workshop designed to empower students in grades 5–8 to become informed, respectful, and confident citizens. This engaging event will help students discover how to apply the Rule of Law and the Constitution to protect their rights, respect the rights of others, and safeguard their mental health. They will also develop the confidence to use their voice to create positive change in their communities. The workshop will be held on Saturday, February 22, 2025, from 10:00 AM to 1:00 PM at United Friends School, located at 1018 W Broad St, Quakertown, PA 18951. Presented by The Legal Kid Foundation, this workshop provides students with valuable tools to navigate their rights and responsibilities in a safe and supportive environment. Spaces are limited, so sign up today!
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:
*
Medication Necessary During Program Duration:
Parent/Guardian Name:
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First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Permission and Consent: I, the undersigned, hereby grant permission for my child to participate in the Student Ambassador Program. I understand that the program may involve educational activities 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:
*
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
*
Please enter a valid phone number.
Phone Type
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Mobile
Home
Parent(s)/Guardian(s) Email Address(es)
*
example@example.com
Best Email address(es) to reach Parent(s)/ Guardian(s)
*
example@example.com
Please indicate other students associated with this student.
Submit
Should be Empty: