Uplift Foundation Program Registration 2022  
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Student's name *
Parent's name *
School name *
Student's grade *
What program(s) would you like to sign-up for? *
(If applicable) What is your debate/public speaking experience? This is by no means required! If none, please write none.
Parents/Guardian email address *
What is the student's gmail account (parents' accounts are fine)? School accounts probably will not allow communication with an outside email address. If the student doesn't have a gmail account, please make one as we will be utilizing it for document sharing. *
Parent/Guardian Signature Required - please sign by entering FIRST AND LAST  name of consenting parent/guardian below. 1. Permission to participate in the Uplift Foundation Program: I do hereby consent that my child may participate in the stated activity. I agree to indemnify, and hold harmless the Uplift Foundation and its agents from any and all liability, penalties, damages, expenses, attorneys' fees and claims caused by or resulting directly from their use of the Uplift Foundation services. 2. Student Code of Conduct: I understand that my child will be expected to maintain appropriate behavior during the stated activity. Student success is our goal, but students who do not complete homework and/or do not pay attention in class may not optimize their success. 3. Media Consent: I, as the parent or legal guardian of the minor named above, hereby grant permission to the Uplift Foundation, or persons contracted by the Uplift Foundation, to take photographs and/or video/audio recordings of my child in connection with his/her participation in the Uplift Foundation online activities he or she registers to participate in. Furthermore, I grant permission to the Uplift Foundation to publish in print, electronic, or video format the likeness or image of my child obtained during time enrolled for relations, educational, or any other lawful purposes. I authorize the use of my child’s likeness or image without compensation to my child or me. All negatives, positives, prints, digital reproductions, and video recordings shall be the property of the Uplift Foundation. *
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