PUSH Excel/St. Sabina/Illinois Judicial Council's Virtual Oratorical Coaching Classes April 17, 2021-June 19, 2021
Oratorical Registration Form
"The Language of Money: Where Words Meet Money"
Email *
Participants Name: *
Are you interested in the: *
Participants Levels: *
Address (Include City, State & Zip Code): *
Phone Number (Area code and Number) *
Email: *
Date of Birth (of participant) *
MM
/
DD
/
YYYY
Age (of participant) *
Grade in school *
School and/or Church: *
Participant Agreement
I have studied the rules of the classes and I will be bound by all of the requirements
Parent or Guardian Signature (type your name) *
Parent or Guardian Permission and Release
I give my permission for my child/ward to participate in these classes. I also consent to my child/ward being photographed or videotaped, including audio, in connection with his or her participation in these classes. I also give PUSH Excel and its assigns permission to use, edit and re-use these products for print, internet, and all other forms of media. I release PUSH Excel, and its assigns, agents and employees from all claims, demands, and liabilities whatsoever and in connection with the above.
Relationship to Participant *
Parent or Guardian Signature (type your name) *
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy