The Blackout Conference Registration

Join us for the Boys of Color Conference on April 6, from 9 AM to 4 PM at the Agricenter. This empowering event, filled with workshops and activities, is aimed at inspiring young men from 3rd grade to high school seniors. Please submit your registration by February 29th. For any questions, email a.moss@thegentsleague.org.

Section 1 - To be completed by Parent/Guardian
Section 2 - To be completed by Student Attending Conference
Sign in to Google to save your progress. Learn more
Student's Name *
Student's Email  *
If the student does not have an email, then add in the parent/guardian's email. 
Student's Contact Number *
If the student does not have a cell phone, then add in the parent/guardian's cell phone. 
Student's Current Grade *
Student's School Name *
Student's T-shirt Size *
Emergency Contact Name *
Should be the Parent/Guardian who is registering the student. 
Emergency Contact Email *
Should be the Parent/Guardian who is registering the student. 
Emergency Contact Number *
Should be the Parent/Guardian who is registering the student. 
Student's Dietary Restrictions (Check all that apply) *
Required
Do you have any medical concerns or conditions regarding your child that we should be aware of during the conference? Please provide details to ensure their safety and well-being.
Conference Permission and Release Form

The Gentlemen’s League (TGL), in partnership with Kudzukian Media Group, is excited to include your child in our upcoming Boys of Color Conference. By completing this registration form, you provide consent for TGL to capture and use images and videos of your child at the event for promotional and educational purposes across various media. These materials are essential for showcasing the conference's impact and furthering our mission. Rest assured, personal identities will be protected and not disclosed in any public media without additional explicit consent. Your support is invaluable, and we are committed to ensuring a positive and enriching experience for all participants.

Please check each of the following:
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy