Rise Up Young Men Teen Summit 2025

"RISE UP YOUNG MEN!" TEEN SUMMIT

Registration - Page 1
Registration Form

March 28th, 2025 | Tulsa Dream Center 200 W 46th St., Tulsa OK 74126
PARTICIPANT INFORMATION
Name*

Last NameFirst Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age: *
School You Attend:*
Grade*
School ID Number:*
6 digit number please
How did you hear about the Rise Up Young Men Teen Summit? (check one)*

FriendRadioSchoolSocial MediaOther
If school or other selected, enter name/details here:
Student Workshop (Electives)

*If a participant is more than 30 minutes late he will lose his spot in one or possibly both sessions. Participants cannot change sessions on arrival.
Please select an elective breakout session*

CulinaryActingBasketballGolf
Parent Guardian Information
Name

Last NameFirst Name
Email
Phone Number

Area CodePhone Number
LOCAL EMERGENCY CONTACT

Provide as much information as possible
Name

Last NameFirst Name
Relationship to the participant:
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number

"RISE UP YOUNG MEN!" TEEN SUMMIT

Registration - Page 2
Acknowledgements & Releases
CAREFULLY READ AND COMPLETE THE REQUIRED ACKNOWLEDGEMENTS BELOW

➔ The above information is true to the best of my knowledge. As the parent/guardian of the above-named participant, I give permission for my child to participate in all "RISE UP YOUNG MEN!" TEEN SUMMIT activities. My child has my permission to be transported to and from this activity. I understand that neither the "RISE UP YOUNG MEN!" TEEN SUMMIT and/or the Tulsa Dream Center, nor any of its agents are responsible for any injury or casualty sustained by my child. If a medical emergency occurs and I cannot be reached or my child needs immediate care, I authorize the staff of Soaring Eagles and the Dream Center to use their best judgment in taking my child to a hospital and/or contacting a medical professional. I further agree to be responsible for any charges incurred in relation to obtaining such medical care.
Please check the acknowledgement box:*

I understand and agree to the participation and injury acknowledgement.
PHOTOGRAPHY RELEASE:

➔ During the course of the "RISE UP YOUNG MEN!" TEEN SUMMIT activities., photos and or video will be taken. Please indicate below if you give permission to use and/or publish photos/video of you or your youth obtained during the event.
I agree to the use/publication of (check one):*

I choseI chose NOT to have any images taken.
➔ All attendees will be responsible for any personal items brought to the event. "RISE UP YOUNG MEN!" TEEN SUMMIT, Soaring Eagles Youth and Family Services, 100 Black Men of Tulsa, Tulsa Dream Center and any of their agents, representatives, and/or volunteers will not be responsible for lost or stolen items. Disruptive conduct will not be tolerated. Any attendees who are deemed to be unruly or disorderly will be required to leave the premises. Transportation from the event will be the responsibility of the parent/guardian.
Please check the acknowledgement box:*

I agree to and understand the personal property and conduct expectations.

➔ We at Soaring Eagles Youth & Family Services encourages young men to seek out and get connected with organizations that provide various services that help positively impact the lives of each young man. While we encourage connecting with mentors, we advise that the young men first connect with an official organization and through the organization to be partnered with an individual mentor. We do NOT advise young men to exchange numbers with event volunteers. Should your child exchange numbers with an event volunteer, Soaring Eagles Youth & Family Services, The Tulsa Dream Center, 100 Black Men of Tulsa, and any other company or organization connected to "RISE UP YOUNG MEN!" TEEN SUMMIT shall NOT be held liable for the outcome of relationship.
Please check the acknowledgement box:*

I understand and agree
IMPORTANT:

Please ensure all appropriate check-boxes are completed above and sign and date this form below.
The undersigned parent/guardian hereby releases Soaring Eagles Youth & Family Services, 100 Black Men of Tulsa, and The Tulsa Dream Center its employees, agents, Board of Directors, and their respective successors and assigns from any and all claims, damages and liabilities, including, without limitation, personal injury, bodily injury, and damage to, or loss of, personal property, including and all costs or expenses related thereto, without limitation, which may be incurred by the undersigned and/or the child identified herein, as the direct or indirect result or consequence for any event which may occur or arise from the attendance and/or participation of the child identified herein, in the event described above, including transportation to and from said event.
Name of Participant:*
Participant Name*

Last NameFirst Name
Parent Signature*

Clear
Date:*
Should be Empty:

"RISE UP YOUNG MEN!" TEEN SUMMIT

Registration Form

Student Workshop (Electives)

Parent Guardian Information

LOCAL EMERGENCY CONTACT

"RISE UP YOUNG MEN!" TEEN SUMMIT

Acknowledgements & Releases

IMPORTANT: