Clone of Tulsa Girls Teen Summit Registration Form 2024

REAL LIFE, REAL TALK Fall 2025

Registration - Page 1
Registration Form

Tuesday Evenings 6:30pm - 7:30pm Location: Tulsa Dream Center 200 W 46th St., Tulsa Oklahoma 74126
PARTICIPANT INFORMATION
Name*

Last NameFirst Name
E-mail*
Date of Birth*

MonthDayYear
Age*
*Participant must be between the ages 12-18.
Grade*
*Participant must be in the 7th-12th grade.
School*
Address

Street Address

Street Address Line 2

CityState

Zip Code
If school or other selected, enter name/details here:
Parent Guardian Information
Name*

Last NameFirst Name
Email*
Phone Number*

Area CodePhone Number

REAL LIFE, REAL TALK

Registration - Page 2
Acknowledgements & Releases
PHOTOGRAPHY RELEASE:

➔ During the course of the Real Life, Real Talk, 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):*

Yes, I agree to the use/publication of photos/videos of me or my youth obtained during the eventNo, I do not agree to the use/publication of me or my youth obtained during the event
➔ All attendees will be responsible for any personal items brought to the event. Real Life, Real Talk, 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.
TRANSPORTATION (check one ONLY): *

I will be responsible for the named participant’s transportation to and from the event.I give permission for Dream Center and SEYFS to provide transportation for the named participant to and from the event.
➔ We at Soaring Eagles Youth & Family Services encourages girls to seek out and get connected with organizations that provide various services that help positively impact the lives of each girl. While we encourage connecting with mentors, we advise that the girls first connect with an official organization and through the organization to be partnered with an individual mentor. We do NOT advise girls to exchange numbers with event volunteers. Should your child exchange numbers with an event volunteer, Soaring Eagles Youth & Family Services, The Tulsa Dream Center and any other company or organization connected to Girls' 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 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:*
Parent Signature*

Clear
Date:*

Health Self Screening Declaration Form

Soaring Eagle’s Youth and Family Service’s
Participant Name*

Last NameFirst Name
Parent/Guardian*

Last NameFirst Name
*Please complete a separate form for each student.

Soaring Eagle’s Youth and Family Services, Inc. is dedicated to the health and safety of our teens and volunteers. Parent/guardians’ commitment to keep their kids home from the event under the circumstances listed below is a very important part of keeping the SEYFS at the Tulsa Dream Center healthy and sustaining uninterrupted in-person learning.

By signing this form, you acknowledge your responsibility and agreement for the SEYFS to keep your teen home if:

1. A member of the household is positive for COVID-19 or is awaiting test results after having had contact with a positive case of COVID-19.

2. A member of the household is experiencing COVID-like symptoms.

3. Student has had close contact with someone diagnosed with COVID-19 within 14 days.

4. Student is experiencing a fever of 100 degrees or higher.

5. Student is experiencing any of the following unexplained symptoms (fever or chills, cough, shortness of breath, fatigue, muscle or body aches, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, headache, loss of taste or smell).

Should any of the above apply to your teen, please refer to your healthcare provider for testing and care, and contact the Executive Director, Premadonna Braddick, by phone (918-739-8336).
Signature*

Clear
Date:*

Should be Empty:

REAL LIFE, REAL TALK Fall 2025

Registration Form

Parent Guardian Information

REAL LIFE, REAL TALK

Acknowledgements & Releases

IMPORTANT:

Health Self Screening Declaration Form