Winter Youth Development Exchange Registration Form

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* 1. Name

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* 2. Email

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* 3. Phone (optional)

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* 4. Zip Code

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* 5. Gender

Male

Female

Non-Binary

Choose not to diclose

Other (please specify)

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* 6. What race are you?

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White

Other (please specify)

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* 7. What grade are you in?

9th (Freshmen)

10th (Sophomore)

11th (Junior)

12th (Senior)

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* 8. Would you like to be notified of future events, products or opportunities?

Yes

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* 9. How did you hear about this event?

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* 10. Acknowledgements:

I grant permission for the organization named above to use photographs of me for any of the following purposes: websites or social media accounts, advertisements, promotional publications, articles, other marketing materials, and internal publications.

I understand that the photographs used online may freely be shared by anyone who has access to internet connectivity and may be published to a local press or media.

I can withdraw the consent I have given at any time. However, I understand that any images already published may not be able to be fully removed from existing materials.

My parent acknowledged this RSVP for this event

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* 11. Parent Signature: I acknowledge that by entering my name above I am providing a digital signature.

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* 12. Date

Date