Young Investors Group Registration Form
Registration is not final until registration form and interview completion are received. Spaces may fill prior to receiving youth spot in the program registration is not guaranteed. The quickest way to finalize your registration is to submit registration forms and schedule your interview.
Email address *
Student First and Last Name* *
Your answer
Grade Level *
School Division *
Your answer
Date of Birth *
MM
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DD
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YYYY
Mailing Address *
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Daytime Telephone
Your answer
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Alternate Contact Phone
Your answer
Allergies/Special Needs
Your answer
T-Shirt Size *
Parent/Guardian Authorization
PHOTO/VIDEO RELEASE: I (parent) do / do not (please circle one) hereby give Young Investor Group, their assigns and legal representative the irrevocable right to use photograph or video images of my child in all forms and media for education or other lawful purposes in its publications and displays. I waive my right to preview or approve the finished product, including written copy that may be created in connection therewith. I understand no fee will be paid to me now or in the future. I have read this release and understand its contents.
TRANSPORTATION RELEASE: I give permission for my child to be transported to activities, riding in approved vehicles, or walking with staff to attend and participate in camp-sponsored activities on and off campus, should program require.
MEDICAL RELEASE: I also give permission to the leaders of this program to secure emergency medical or surgical treatment for my child if there is insufficient time to contact me, and to secure routine, non-surgical medical care as needed.
WAIVER OF LIABILITY: I agree to indemnify, release and hold harmless Young Investor Group, the State of Virginia, and their respective officers, agents, employees and volunteers from any and all costs, liabilities, expenses, claims, compensation, demands, or causes of action on account of any loss or damage to person or property of the aforementioned child arising out of or in connection with his/her participation in the aforementioned camp and related camp activities
Signature of Parent/Guardian (Your typed first, last and middle name serves as a signature) *
Your answer
Date
MM
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DD
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YYYY
Student Code of Conduct (Parent/guardian to review and student to sign)
I will treat fellow students, YIG faculty and staff with respect at all times, including: respectful listening, participation during hands on activities, avoid distracting behavior and follow directions from YIG staff as necessary to ensure a safe and enjoyable experience by all. I understand that the University reserves the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety or welfare of others. I understand that cell phones and electronic games are allowed for limited use as permitted during breaks. I understand that the consequences for breaking these rules may include; (1) a warning from the Instructor; (2) meeting with Engagement Coordinator and/or staff; (3) a phone call and/or meeting with the parent/guardian;
(4) being asked to leave the program without a refund.
Student Signature (Your typed first, last and middle name serves as a signature)
Your answer
Date
MM
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DD
/
YYYY
Email younginvestorsofva@mail.com to request cancellation.
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