Flip The Script Registration & Waiver Form

Flip The Script Registration & Waiver Form

Complete this form to register and agree to the program's terms and conditions.
Participant Information
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP Code
School Name
Current Grade Level
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Signature
Entrepreneurship Interests
Entrepreneurship Interests

Other
What business ideas or goals are you interested in pursuing?
Program Expectations
Program Acknowledgment
Participation Expectations Acknowledgment
Program Terms Acknowledgment
Liability Waiver & Media Release
I have read and agree to the waiver and release terms.
Participant Signature
Parent/Guardian Signature
Communication Opt-In
I agree to receive text messages, updates, reminders, opportunities, and program information from Be The Proof Foundation.
I agree to receive emails, newsletters, updates, opportunities, and announcements from Be The Proof Foundation.
Should be Empty:

Flip The Script Registration & Waiver Form

Participant Information

Parent/Guardian Information

Entrepreneurship Interests

Program Expectations

Liability Waiver & Media Release

Communication Opt-In