4C the Power Workshop Registration

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Please complete the following registration for a 4C the Power Workshop. Complete your personal information and then select your 1st, 2nd and 3rd choice of workshop. If you are under 18 years of age, you must also have your parent or guardian confirm their permission for you to participate in a 4C the Power Workshop. For question please email 4cthepower@gmail.com

Last Name *

First Name *

Address *

Street Address, City, State and Zip Code

Email Address *

Cell Phone Number *

Name of School/Place of Work *

Year in High School/ Year Graduated from High School *

Which 4C the Power Workshop location will you be attending? *

What is your 4C the Power Workshop 1st Choice? *

Hip Hop Music

Acoustic Music

Dance

Filmmaking

Photography

Comedy/Acting

What is your 4C the Power Workshop 2nd Choice? *

Hip Hop Music

Acoustic Music

Dance

Filmmaking

Photography

Comedy/Acting

What is your 4C the Power Workshop 3rd Choice? *

Hip Hop Music

Acoustic Music

Dance

Filmmaking

Photography

Comedy/Acting

Parent/Guardian Permission (participants under 18 years of age) *

My son/daughter has permission to participate in the 4C the Power Workshops. I understand that 4C the Power, iMovement Foundation,ISA or any of its affiliates, as well as the artists and their affiliates will not be held responsible for any injury, damages, lost or stolen property.

Required

Parent/Guardian Electronic Signature *

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