Parent Authorization Form
Event Timing: 10am-12:00 pm Saturdays (Every 3rd of the month)-Starting Sept 26, 2020 to April 17, 2021

Registration fees:
New Member - $55
Returning Member - $45
Late Registration (After October 3rd)- $70

Contact us at
Email address *
Parent/Guardian Full Name *
Phone Number *
Home Address (Address, City, State, Zip Code) *
Please list all of the students you are registering (*NOTE* Each student MUST be registered separately. A separate application MUST be filled out for each student. The application can be found here:
Photo and Video Authorization: I hereby acknowledge and grant the Atlanta Professionals District Wide NSBE Jr., its photographers, videographers, representatives, and employees the final right and permission, to take photographs, and/or videos of me and/or my child while engaged in Atlanta Professionals District Wide NSBE Jr. activities; with the right to copyright, use and publish in print and/or electronically for program marketing purposes only. *
Package Pick Up: This year we will be sending all of the materials needed for our hands-on activities in packages. Please list any individuals who you authorize to pick these packages up along with their home addresses. We will use the address to determine the best pickup location. The listed individual is required to show a valid ID for pick-up. Please enter the following: Name, Address, City, State, Phone Number *
Parents are required to volunteer at least 4 hours to assist with the District-Wide NSBE Jr. Programming. Please select the following date(s) that you will volunteer. (required) *
Parents are requested to volunteer at least 4 hours to assist with the District-Wide NSBE Jr. Programming. Please select from the following roles available for parent volunteers:
Parents are an essential component to a successful NSBE Jr. Chapter. In addition to monthly meeting programming for academic enrichment and the 3C's (Character, College and Career) development, students will also have the opportunity for HOMEWORK HELP to aid academic excellence. This homework help will be virtual. Students can pose their questions and one of our members will answer the question during our weekly session. *
Attendance is essential to successful outcomes of our programs. Students are allowed no more than one (1) consecutive absences and no more than a total of two (2) absences for the entire programming. *
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