Teen Summit: S.O.A.R. Registration Form
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Registration Type *
Participant's Full Name *
Gender: *
Name of School: (Enter N/A if Registering for Adult Only Session) *
Grade - Upcoming School Year: (Enter N/A if Registering for Adult Only Session) *
Age at Time of Participation: (Enter N.A if Registering for Adult Only Session) *
Parent/Guardian Name (if Registering for Teen Workshops)
Address *
Phone Number *
Email *
Emergency Contact Name *
Emergency Contact Number *
T-Shirt Size (Adults Sizing Chart)  

 *
Please list any Food Allergies
Medical Emergency Authorization And Health Information  

In the event of a medical emergency, we will contact 911 and notify the emergency contact that has been listed on the registration form. All medical care will be administered by an authorized health practitioner. 
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Parental Permission and Release of Liability  

I hereby give my minor child (named above) permission to participate in the event listed. I hereby waive Alpha Kappa Alpha Sorority, Inc.®, its officers, board and employees, event coordinators, chapter members, and volunteers from any liability that may arise due to personal injury, personal illness, loss or damage to personal property of my minor child that may arise from participating in the event listed. As a participant in a volunteer program, I understand that my minor child is not covered under the insurance policies of Alpha Kappa Alpha Sorority, Inc.® or any of its chapters. I acknowledge that I understand the waiver described in this document and assume the risk of personal injury to my minor child and property loss associated with my minor child’s participation. This waiver is made to the maximum extent permissible under applicable law.   Alpha Kappa Alpha Sorority, Inc.® is not responsible for the transporting of participants to and from the event.
 *
Participant Media Release Form

Alpha Kappa Alpha Sorority, Incorporated® routinely promotes programs and activities involving community participants through various media. Alpha Kappa Alpha Sorority, Incorporated® owns the rights to any pictures taken. 

MEDIA RELEASE 

If you do NOT wish the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of your child or yourself for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Web site, please select OPT OUT.
*
  Electronic Signature   

The electronic signature, and all of its related fields, replaces a handwritten signature on paper and is legally binding. I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated like a handwritten signature on a paper form.

Parent/Guardian/Participant Signature   
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