The Readiness Program's POWER Workshop Registration

The Readiness Program's POWER Workshop Registration
Student Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
What gender/sex do you identify as?*

FemaleMaleNon-binaryPrefer not to say
Email*
example@example.com
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Which school do you attend?*
Other School*
What grade are you in/going to?*
Other*
What is your home zip code?*
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Scholarship Success Workshop
Choose your preferred session

April 11, 9:00a - 3:00p
Choose your preferred session

October 13-15, 5:00p - 7:45pOctober 18, 9:00a - 6:00pNovember 17-19, 5:00p - 7:45pNovember 22, 9:00a - 6:00p
Choose your preferred session

November 17-19, 5:00p - 7:45pNovember 22, 9:00a - 6:00p
Career Readiness Workshop
Choose your preferred session

April 18, 9:00a - 3:00p
Choose your preferred session

October 20-22, 5:00p - 7:45pOctober 25, 9:00a - 6:00pDecember 15-17, 5:00p - 7:45pDecember 20, 9:00a - 6:00p
Choose your preferred session

December 15-17, 5:00p - 7:45pDecember 20, 9:00a - 6:00p
Acknowledgements
Please describe any special conditions or requirements you have. (i.e. accessibility needs, allergens). If there are none, input None or N/A.*
Question*

By checking this box, I, parent of registrant, am aware photographs and videos will be taken and used for marketing including the use of social media for this program. I give authorization for my child and/or myself to be photographed or videoed. If you do not grant permission, please contact us at 706.464.3035.
I, parent of registrant, am aware of this workshop and have granted my child permission to attend.*

YesNo
Future Leader's Oath
When submitting this registration, you agree to:
- Investing in yourself and not waiting for someone else to do it for you.
- Knowing you matter and therefore, will fully participate in this workshop to maximize your opportunity.
- Sharing each day something you gained from participating in this workshop.
- Telling your parent/guardian 'Thank You' each day of this workshop.
Should be Empty:

The Readiness Program's POWER Workshop Registration

Scholarship Success Workshop

Career Readiness Workshop

Acknowledgements

Future Leader's Oath