Hidden Figures Watch Party with Girls LEAD!
DATE: March 20, 2021
TIME: **12:00pm - 2:30pm**
LOCATION: Zoom (Link sent upon completion of this registration form to the email address provided below.)
Registration due as soon as possible.
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Email *
Do you grant your child permission to participate in the Hidden Figures Watch Party? *
Student Participant Information
Student's First and Last Name *
Student's Age *
Student's Birthday *
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Student's School *
Student's Grade *
Student's Email *
Student's Address *
Parent/Guardian Information
Parent/Guardian's First and Last Name *
Relationship: *
Parent/Guardian's Address *
Parent/Guardian's Phone Number *
Parent/Guardian's Email Address
Would you like to receive Girls LEAD! text reminders? *
Where did you hear about Girls LEAD! and/or the Hidden Figures Watch Party? *
Required
Photo Consent: I hereby authorize and consent to the use of any photographs, videos, recordings, or other records in which my child appears. I understand that my child’s name will not be given, and the photographs/videos will be used in public domains (website, publications) and may be submitted to funding organizations. I waive any right to inspect and/or approve the finished product or advertising copy that may be used or the use to which it may be applied. I hereby release, discharge, and agree to waive Girls LEAD! of YWCA Dayton from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in the taking of said picture/video; or in any processing tending towards the completion of the finished product.   *
Required
I certify that I have read and fully understand this Waiver, Release, and Consent; that I execute the same voluntarily and of my own free will; and that I am of lawful age and legally competent to do so.  In executing this Waiver, Release, and Consent, I do so on behalf of myself and my child. *
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