Embrace Them Registration

We are excited to have your youth experience this groundbreaking collaboration! Four esteemed organizations, Helping Our Adolescents Prosper (HOAP), Better Wiser Stronger, Young Money Finances, and Girls Growing II Women (GG2W), have joined forces to create “Embrace Them,” a transformative summer program designed to uplift and empower Black and Brown youth.

This initiative will provide participants with access to a holistic series of workshops focused on: Leadership Development, Mental Health & Emotional Wellness, Financial Literacy, Self-Esteem and Personal Growth. Participants will also engage in meaningful discussions, explore strategies for personal and professional success, and collaborate with peers to shape their future and that of their communities. Workshops kick off Tuesday, July 7th- July 30th, Tuesday- Thursday from 12:00 pm to 2:00 pm.

Name

First NameLast Name

D.O.B

Date

Grade 2026-2027 School Year

Gender

Race

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T- Shirt Size

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Name

First NameLast Name

Relationship to participant

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please share any allergies, medical conditions, and or chronic illnesses that we need to be aware of:

Informed Consent and Acknowledgement:

I hereby give my approval for my child’s participation in any and all activities prepared by Embrace Them during the selected workshop series. In exchange for the acceptance of said child’s candidacy by Embrace Them, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Embrace Them and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected workshop sessions.

In case of injury to said child, I hereby waive all claims against Embrace Them, including all staff, volunteers, board members and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization:

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is also granted to Embrace Them and its affiliates including directors, staff and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photo and Video Consent: I hereby authorize Embrace Them to take photos and videos and I give consent to publish the photographs and utilize videos taken of my child for use in Embrace Them for printed publications, marketing collateral, website, and/or social media.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Date

Embrace Them Registration

Welcome to Embrace Them!

Participant's Information

Parent/Guardian Information

Emergency Contact