BRIDGE Bootcamp

BRIDGE Bootcamp Application

BRIDGE Bootcamp is for every kind of learner who wants support building skills to manage their time and tasks as they take on more responsibility as a teen or young adult. By the end of BRIDGE Bootcamp, participants will: Have a personalized organizational system that fits how they work. Feel more confident navigating the demands of high school or college. Walk away with strategies they can use right away.
Full Name

First NameLast Name
Preferred Name
Age
Grade and School for the Fall
Example: 10th Princess Anne High School
Student Email Address
example@example.com
Parent or Guardian Email Address
who else should receive information about the program besides the participant
Parent or Guardian Name

First NameLast Name
Student Phone Number
OptionalFormat: (000) 000-0000.
Parent or Guardian Phone Number
Mandatory if student is under 18Format: (000) 000-0000.
Do you have an IEP or 504 at school?
If you get any accommodations at school, what are they?
Type N/A if not applicable
What is the best way CAYA can support you?
Repeat instructions, extra processing time, materials ahead of time, materials in digital format, etc.,
What are the top things you want to work on?

Other
Other
Why do you want to join this program?
How did you hear about us?
Do you need assistance with covering the $200 program fee?
Participant Waiver and Release of Liability
In consideration of being permitted to participate in the programs, activities, and events of Come As You Are Inc., I, the undersigned participant, or the parent or legal guardian of the participant, hereby agree to the following: Assumption of Risk: I understand that participating in Come As You Are Inc.’s programs, activities, and events may involve inherent risks, including, but not limited to, physical exertion, interaction with other participants, and exposure to various environments. I voluntarily assume all risks associated with my participation. Release of Liability: I, for myself, my heirs, executors, administrators, and assigns, hereby release, waive, discharge, and hold harmless Come As You Are Inc., its directors, officers, employees, volunteers, agents, and affiliates from any and all claims, demands, liabilities, damages, injuries, actions, or causes of action arising out of or in connection with my participation in Come As You Are Inc.’s programs, activities, or events, including any claims arising out of negligence. Photographic Release: I grant Come As You Are Inc. the right to take photographs and videos of me during the programs, activities, and events. I agree that Come As You Are Inc. may use such images for promotional, educational, and other purposes without compensation to me. Behavior and Conduct: I agree to follow all rules, guidelines, and instructions provided by Come As You Are Inc. staff and volunteers. I understand that failure to adhere to these rules may result in my removal from the program, activity, or event without refund. Confidentiality: I understand that certain information disclosed during my participation in Come As You Are Inc.’s programs, activities, or events may be confidential. I agree to maintain the confidentiality of such information and not disclose it to third parties without the prior written consent of Come As You Are Inc. Indemnification: I agree to indemnify and hold harmless Come As You Are Inc., its directors, officers, employees, volunteers, agents, and affiliates from any and all claims, demands, liabilities, damages, injuries, actions, or causes of action arising out of or in connection with my conduct or actions during my participation in Come As You Are Inc.’s programs, activities, or events.
Signature of CAYA program participant that is 18 or older
Participant Name

First NameLast Name
Waiver and Release of Liability
Signature of parent or legal guardian if CAYA participant is under 18
Guardian Name

First NameLast Name
Should be Empty:

BRIDGE Bootcamp Application

Participant Waiver and Release of Liability