Design Your Future Workshop

Participant's Information

Gender

Parents/Guardian Information

Emergency Contact Info *

Medical Information

Does the participant have any allergies, medical conditions, or special needs? *

Yes

No

If yes, please list medications:

Photo/Video Release

I grant permission for my child (or myself, if a teen participant) to be photographed or recorded during the event for promotional purposes. *

Yes

No

Liability Waiver & Consent

I, the undersigned, acknowledge that participation in this event is voluntary. I hereby release the event organizers, sponsors, and affiliates from any liability for injuries, damages, or losses sustained by the participant during the event. I also understand that in the event of a medical emergency, every effort will be made to contact me. If I cannot be reached, I give permission for emergency medical treatment to be administered. *

Yes

Parent/Guardian Signature (if under 18):

Clear

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