OneStep Participant Form

Participant Details:

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Phone Number

Format: (000) 000-0000.

E-mail

example@example.com

Program enrolled?

What is the location of your enrollment?

How did you hear about us?

If referred by a mentor, please provide their name.

Please provide their contact information.

Would you consider yourself to be self sufficient?

What type of support is needed? (Check all that apply)

Please explain the specific support that is needed.

Do you agree to receive mentoring and/or support services?

Photo Release and Consent

I, the undersigned, hereby grant [Your Organization Name], its representatives, employees, and authorized agents the irrevocable right to use photographs and/or video recordings of me or my minor child(ren), taken in connection with activities or events associated with YAAYME, for promotional purposes.

I understand that these photographs and/or video recordings may be used in various forms of media, including but not limited to:

Print materials (brochures, flyers, posters, etc.)
Digital media (websites, social media, online advertising)
Presentations and promotional displays
Any other forms of communication for promotional purposes
I waive any right to inspect or approve the finished product, including written copy that may accompany the photographs or video recordings, and I acknowledge that I will not receive any compensation for the use of such materials.

By signing below, I release YAAYME and its agents from any liability that may arise from the use of these images or recordings, including claims of defamation or violation of privacy or publicity rights.

Acknowledgment
I am at least 18 years of age and am competent to contract in my own name.

Print Name

Signature