2nd District Youth STEM Symposium

Primary Parent Name*

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Primary Parent Email *

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Name*

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Date of Birth (month/day/year)*

Grade for 2025-26 School Year*

School attended in 2025-26*

Disclaimer

Registration for the 2nd District Youth STEM Symposium serves as an application for participation and does not guarantee acceptance into the event. All information submitted must be accurate and truthful. Any false or misleading information may result in denial or removal from the program.

The program reserves the right to dismiss any participant at its discretion for reasons including, but not limited to: misconduct, inappropriate behavior, failure to participate, chronic absenteeism, or any actions deemed inconsistent with the values and expectations of the Symposium.

By typing my name, I am stating that I am authorized to complete this form on behalf of the participant *

I hereby consent to have my child, named above, attend and participate in the 2026 Omega Psi Phi Fraternity, Inc 2nd District Youth STEM Symposium. I understand that participation in activities involves inherent risks and potential for injury. By providing my consent, I acknowledge these risks and agree to release and hold harmless Omega Psi Phi Fraternity, Inc., Omega Psi Phi Fraternity, Inc, Prince George’s County Public Schools, Prince George's County Government, Friendship Charities Foundation, Inc., Charles Drew Memorial Scholarship Fund and any of their staff, subsidiaries, affiliates, or successors from any damages, injuries, or legal liability that may arise from my child's participation in the program of whatever kind related to me or my child’s attendance and participation. I further acknowledge and understand that participation is voluntary and that I am knowingly waiving my and my child’s right to seek any damages against any of the aforementioned organizations as a result of their participation in this event.

By typing my name, I am stating that I am authorized to complete this form on behalf of the participant *

Media Release Authorization

Omega Psi Phi Fraternity, Inc. 2nd District, Friendship Charities Foundation, Inc., Charles Drew Memorial Scholarship Fund and its affiliates periodically use photographs, videos, profiles, and personal stories for promotional, advertising, commercial, educational, research, and archival purposes. In support of these efforts, the organization may collect individual and group images, testimonials, and related content featuring our volunteers, supporters, and program participants.

We request your permission to use your child’s photograph, video, profile, and/or story in materials designed to promote and advance our programs and initiatives.

By signing below, I grant Omega Psi Phi Fraternity, Inc. 2nd District, Friendship Charities Foundation, Inc., Charles Drew Memorial Scholarship Fund and its affiliates the irrevocable and unrestricted right to use and publish photographs or video images of my child, including those in which I may appear, for any purpose authorized by the organization. This includes, but is not limited to, use on websites, editorial publications, catalogs, and advertising materials. I understand that the organization may edit, modify, or retouch these images at its discretion.

I acknowledge that such materials may be distributed globally and that I will receive no compensation for their use. I further understand that I will not have the opportunity to review or approve the final products or accompanying text prior to publication.

By granting this permission, I fully release Omega Psi Phi Fraternity, Inc. 2nd District and its affiliates from any and all liability that may arise from the use of these images.

Acknowledgment and Authorization Statement: By signing below, I affirm that I am legally authorized to complete this form on behalf of the minor named herein. If the applicant is selected, I agree that he will comply with all program policies, expectations as outlined. I understand that failure to adhere to these policies may result in dismissal from the program.*

Date Signed*

Date

2nd District Youth STEM Symposium

Youth Information

Photo Waiver