Be Great Foundation - Game Design Workshop

Thank you for your interest in particpiating in our Builders + Dreamers Game Design Workshop. We are excited about offering this workshop to the community and feel that your child will gain a lot form this program not only in the form of new skills, but also in terms of career inspiration.

This workshop is FREE to participate so we have a very limited number of spaces. At times, we may have community partners who are interested in telling the story of Be Great Foundation so that we may serve more children and young adults in our community. They may capture video footage, images, and/or interview you and your child regarding our programs. Your submission of this form indicates your willingness to adhere to our photo release policy detailed in the consent and acknowledgment below.

Our workshop will be held on Saturdays at Transform GSO from 11:30 am- 1pm. Dates for this workshop are as follows:

Session 1 - April 6th
Session 2 - April 13th
Session 3 - April 20th
Session 4 - April 27th
Session 5 - May 4th
Session 6 - May 11th
Session 7 - May 18th
Session 8 - May 25th

Participant's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

School

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Can your child commit to attending all 8 sessions?

( For the Participant/Student to answer) What do you hope to gain from participation in this workshop?

Does your child have any allergies or dietary restrictions? If so, please specify below.

Does your child(ren) have access to a laptop device that they may use for specified sessions?

YesNo

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in the Dreamers + Builders program by {Organization} during the selected program session which will be conducted in person from April 8th to May 27th. In exchange for the acceptance of said child’s candidacy by {Organization} , I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless {Organization} and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against {Organization} . including all staff, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Additionally, I hereby authorize Be Great Foundation to utilize photos and videos that may be captured during this workshop for purposes of marketing, media or program evaluation. Be Great Foundation certifies that all video and images will be utilized in a manner that is appropriate, professional, and favorable for the child/family. Any specific potential media opportunities will be discussed with parents/family prior to the event to ensure all parties are in agreement.

How did you hear about this opportunity?

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Be Great Foundation: Builders + Dreamers