2022 Registration: FBB Literacy & Education
Registration Form 2022
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Today's Date *
Participant's Name: *
Participant's Phone Number *
Parent/Guardian Name: *
Parent/Guardian Phone Number
New or Returning Participant *
Address: Street, City, State and Zip Code *
Parent's E-Mail Address: *
County *
Participant's Sex: *
Participant's Age: *
Participant's Date of Birth *
Race *
Number of People in Household? *
Number of Parents in household? *
Parent's Date of Birth *
Household Annual Income: *
School *
Grade: *
Shirt Size *
Pants Size *
Emergency Contact Name (other than parent/guardian) *
Emergency Contact Telephone (other than parent/guardian) *
Emergency Contact Relationship *
I agree that my child(ren) will attend group and one-on-one sessions with a mentoring coach. (1.5 hours required per week) *
I agree to take pictures and videos of my child(ren) upon request. *
Family Biz Builder promotes the organization on social media (website, Facebook, Instagram, Twitter and LinkedIn). I agree that my player's photos can by published online.
I understand that Family Biz Builder will not be held responsible for any inappropriate use of internet sites while participating in Biz Builder Program trainings. *
I agree to participate in parent meetings and training courses. *
Are you interested in working part-time as a Mentoring Coach? *
Would you like to be a Volunteer in the Literacy & Education Program? *
Parent/Guardian Electronic Signature *
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