Youth Program Registration

1
Parent or Legal Guardian Full Name
First Name
Last Name
2
Relationship to Youth:
3
Phone Number
4
Email
example@example.com
5
Emergency Contact Full Name and Phone Number
6
How many youth are you registering.
1
2
3
4
7
Youth 1 Full Name
First Name
Last Name
8
Youth 1 Date of Birth
9
Youth 1 Current Grade Level
10
Please select all that applies for Youth 1:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Hispanic
Other Race
11
Medical & Special Needs Information for Youth 1:
Please explain if your youth has allergies, medical conditions, or special needs we should be aware of.
12
Youth 2 Full Name
First Name
Last Name
13
Youth 2 Date of Birth
14
Youth 2 Current Grade Level
15
Please select all that applies for Youth 2:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Hispanic
White
Other Race
16
Medical & Special Needs Information for Youth 2:
Please explain if your youth has allergies, medical conditions, or special needs we should be aware of.
17
Youth Full Name 3
First Name
Last Name
18
Youth 3 Date of Birth
19
Youth 3 Current Grade Level
20
Please select all that applies for Youth 3:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Hispanic
White
Other Race
21
Medical & Special Needs Information for Youth 3:
Please explain if your youth has allergies, medical conditions, or special needs we should be aware of.
22
Youth 4 Full Name
First Name
Last Name
23
Youth 4 Date of Birth
24
Youth 4 Current Grade Level
25
Please select all that applies for Youth 4:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Hispanic
White
Other Race
26
Medical & Special Needs Information for Youth 4:
Please explain if your youth has allergies, medical conditions, or special needs we should be aware of.
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Program Participation & ConsentPlease read and check all that applies.
I give permission for my elementary youth above to participate in Sobrosol Productions Inc. youth programs.
I give permission and understand my middle school youth above will be enrolled in Sobrosol Productions Inc. & NAACP ACT-SO Jr. youth programs as a joint collaboration.
I understand that monthly dues are $10 per youth and are used to support program snacks and supplies. Dues for middle school youth are sponsored by the NAACP ACT-SO Jr. youth programs.
I give permission for my youth to receive basic first aid treatment if necessary.
I give permission for my youth’s photo or video to be used for program-related promotional purposes.
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Terms and Conditions:

By submitting this form, you acknowledge that you agree to abide by the rules and regulations of programming.

You understand that the registration fee is non-refundable.

Participants provide Sobrosol Productions Inc. and NAACP ACT-SO Jr. permission to take photographs or video of the youth listed above and to use the photographs, video or audio in its print and internet publications or productions, including advertising, signage and promotional materials, and for commercial purposes. Participants are assigned all rights, title and interests. Participants agree that the photographs and video are the property of Sobrosol Productions Inc. and hereby release Sobrosol Productions Inc. and NAACP ACT-SO Jr. from any claims that entry participants may have from its use of images or voice, including but not limited to any claim for compensation.

You assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Sobrosol Productions Inc. and NAACP ACT-SO Jr. all its respective officers, agents, and representatives from any and all liability for injuries. In case of injury, you hereby waive all claims against Sobrosol Productions Inc. and NAACP ACT-SO Jr. including all event staff, vendors and affiliates, all participants, sponsoring agencies, volunteers,mentors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
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My Products
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
Youth Workshop Payments
$10 per youth. Paying at the door use promo code: Cash
Edit
Back
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1
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Number of Registered Youth
Subtotal:
Enter Coupon
Total cost
Payment Methods
First Name
Last Name
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Parent or Legal Guardian Signature
Should be Empty: