The Axiom Registration

The AXIOM Registration Form

2023-2024
The mission at The Axiom is to equip and empower youth to reach their untapped potential.

The Axiom is not just a building. Our goal really is to equip youth to discover their true value, their untapped potential. We desire that today’s youth will walk in their purpose in life. The Axiom helps to provide youth with a community of people they can rely on, people that rally around you, the parent/guardian, to help guide them as they are making important life decisions. Together we can overcome the great obstacles faced today, in order to secure a better future for tomorrow.

Your student, will have access to many opportunities for growth, training, development, and most importantly,opportunities to develop necessary life skills.

The Axiom is free of charge. Our doors are open Monday through Friday 2pm-6pm during the school year. We will have special events that vary in time and would love to have your student(s) present. More info will be provided.

The AXIOM

PARTICIPANT WAIVER, PHOTOGRAPHY RELEASE AND WAIVER OF LIABILITY
Parent/Guardian Legal Name*

First NameLast Name
Name of Minor First Name Last Name
has my (our) permission to participate in The Axiom programs, events and activities. I understand and acknowledge that participation in any event or activity poses risks to my child, including the risk of injury, illness, and serious injury or death.

I (we), as parent(s) or guardian(s) of the minor, do hereby, for my child, myself, my heirs, executors and administrators, release and forever discharge The Axiom and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the minor’s participation in the above noted event.

I hereby certify that I have parent/guardianship of the above named minor and that his/her date of birth is {studentBirthdate35} and I do hereby certify that to the best of my knowledge and belief said minor is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.
I hereby advise that the above named minor has the following allergies, medicine reactions or unusual physical conditions, which should be made known to a treating physician: (If none, please write the word “none”.)
I grant consent that any pictures taken during The Axiom hours and Special Events, by the Axiom staff and/or hired proffesionals, of my child(ren) may be used for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content.

YesNo
By signing this document I hereby confirm that all the above information is correct.

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Parent/Guardian Name*

First NameLast Name
Preferred Name
Parent/Guardian Phone*
Parent/Guardian Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Second Parent/Guardian Name

First NameLast Name
Second Parent/Guardian Phone
Second Parent/Guardian Email
Student Name*

First NameMiddle NameLast Name
Student Phone Number
Student Email
Student Birthdate*

MonthDayYear
Student Age*
Student Grade in School Fall 2023
What school does student attend?
How did you find out about The Axiom?
When you hit "Submit Application", You will recieve an email with a QR Code. Please scan the QR code to download the MinHub portal app. We will use this app for all communications for the school year.
Should be Empty:

	First Name	Head of Household	Co-Head of Household	Disabled	62yrs or older	Full-time student over 18yrs old	Under 18yrs old	Under 15yrs old
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The AXIOM Registration Form

The AXIOM