2019 NYC Youth Leadership Conference (Parents/Guardians)
This is the form for Parent/Guardian participants. Do not use this form to register Students or to register as a Volunteer.
Email address *
First Name *
Your answer
Last Name *
Your answer
Gender *
House number and street *
Your answer
Apt #
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
E-mail Address *
PLEASE MAKE SURE THIS E-MAIL ADDRESS MATCHES THE E-MAIL ADDRESS YOU PUT AT THE TOP OF THIS FORM.
Your answer
Emergency Contact (NAME AND PHONE NUMBER) *
Your answer
Please list any allergies, dietary restrictions, or medical concerns
Your answer
What is your job/career field? *
Your answer
List any activities or interests of yours *
Your answer
How did you hear about this year's Conference? *
Your answer
Did you attend last year's Youth Leadership Conference? *
Name your child or children attending this year's Conference *
Your answer
Did your child or children attend last year's Youth Leadership Conference? *
PHOTO AND VIDEO RELEASE *
I hereby grant the Invictus Greater New York City Foundation Inc. the rights of my image, likeness, and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed, and waive the right to inspect or approve the finished product wherein my likeness appears. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. Photographic, audio, or video recordings may be used for the following purposes: Conference presentations, Promotional materials, Informational presentations, Online educational courses, or Educational videos. By checking the box below, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. By checking the box below, I acknowledge that I have completely read and fully understand this release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
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