Mom & Me Automotive WorkshopRegistration Form
Section 1 — Parent / Participant Information
1) Mother's Name
*
First Name
Last Name
2) Email Address
*
example@example.com
3) Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
4) Zip Code
*
Section 2 — Emergency Contact (In case the participating parent becomes injured or needs assistance.)
5) Emergency Contact Name
*
First Name
Last Name
6) Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
7) Relationship to Participant
*
Section 3 — Participant Age Requirement.This workshop is designed for youth ages 11–18.
8) This workshop is designed for youth ages 11–18. By registering, you confirm that the student(s) attending the workshop meet the required age range.
*
I confirm the student(s) attending are between 11 and 18 years old
Section 4 — Student Participation
9) How many students will attend with you? Note: Maximum of 3 students per mom.
*
1 student
2 student
3 student
Student #1 Information
10) Student #1 Name
*
11) Student #1 Age (Must be between 11–18)
*
12) Student #1 Grade
*
Student #2 Information (Conditional)
13) Student #2 Name
14) Student #2 Age
15) Student #2 Grade
Student #3 Information (Conditional)
16) Student #3 Name
17) Student #3 Age
18) Student #3 Grade
Section 5 — Allergies or Medical Conditions
19) Do any participants have allergies or medical conditions we should be aware of?(This information will only be used to help ensure participant safety during the workshop.)
*
Section 6 — Workshop Safety Requirements
20) For safety reasons, all participants must follow these guidelines during the workshop.✔ Wear closed-toe shoes✔ Wear clothing that can get dirty (pants recommended)✔ Tie back long hair✔ Avoid loose jewelry✔ Follow all instructor safety instructions
*
I understand and agree to follow the safety requirements
Section 7 — Liability & Behavior Waiver
21) Parent & Participant Liability and Behavior Agreement"I am registering myself and the student(s) listed above for the Mom & Me Automotive Workshop at Auto Pros Academy.I understand that this workshop involves hands-on automotive activities, which may include tools, vehicle components, and mechanical demonstrations. I acknowledge that these activities involve inherent risks.I agree to release and hold harmless Auto Pros Academy, Auto Pros Automotive Repair, Lancaster Automotive Business Park LLC, its staff, instructors, and volunteers from liability for any injury, loss, or damage that may occur during participation in this workshop, except in cases of gross negligence.I understand that this workshop takes place in an automotive environment and agree that both I and my student(s) will follow all safety rules and instructions provided by staff and volunteers at all times.I also understand that participants who do not follow safety rules or staff instructions may be asked to leave the workshop to ensure the safety of all participants.
*
I understand and agree to the Liability & Behavior Waiver
Section 8 — Photo / Media Permission
22) Photo & Media Release Auto Pros Academy may take photos during the workshop for educational and promotional purposes.
*
Yes, I give permission for photos to be used
No, I prefer that photos of my student(s) not be used
Section 9 — Parking Instructions
23) Parking at the Lancaster Business Park is limited.Participants attending the Mom & Me Automotive Workshop should park in the large shared parking lot near Texas Cattle Company, but please park near the vacant bank building in the same parking lot, not directly in front of the restaurant.This helps ensure we do not interfere with restaurant customer parking and helps prevent any vehicles from being towed.Participants are also welcome to park along J4 Street if they prefer street parking.From either location, it is just a short walk to the Auto Pros Automotive location where the workshop will take place.
*
I understand the parking instructions and will park near the vacant bank building in the shared lot or along J4 Street.
Section 10 — How Did You Hear About Us
24)How did you hear about the Mom & Me Automotive Workshop?
*
Auto Pros Academy Website
Social Media
School
Friend / Family
Community Event
Flyer
Other
If other, how?
Section 11 — Future Workshop Updates
25) Would you like to receive updates about future Auto Pros Academy workshops and programs?
*
Yes
No
Section 12 — Final Confirmation
26) Participant Confirmation"I confirm that the information provided is accurate and that I will attend the Mom & Me Automotive Workshop with the student(s) listed above to this free event that is fully Business Sponsored."
*
I confirm my registration
Section 13 — Parent Signature
27) Signature
*
Time
Hour Minutes
AM
PM
AM/PM Option
Register
Register
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