Ekam USA Youth Ambassador Info Form (Age 14 and higher)
Please fill the form with the youth ambassador and parent details. At least one parent participation is mandatory.
First Name (Youth Ambassador) *
Your answer
Last Name (Youth Ambassador) *
Your answer
Age *
Your answer
Grade *
Your answer
Email (Youth Ambassador) - if available
Your answer
Phone Number (Youth Ambassador) - if available (111-111-1111)
Your answer
First Name (Parent that will be involved in the program) *
Your answer
Last Name (Parent) *
Your answer
Phone Number of Parent (111-111-1111) *
Your answer
Email (Parent) *
Your answer
City *
Your answer
State *
Select a Chapter *
Role(s) Youth Ambassador is interested in
WAIVER: In consideration of Ekam USA allowing me/my child/my organization/my family to participate in volunteering opportunities and being aware of the possible injuries or harm that could occur as a result of this participation, I, on behalf of myself, my child, my organization, my family, release Ekam USA, its employees, agents, instructors, from any and all injuries and damages whatsoever arising from participation in events
Waiver *
Required
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