Fayola Man Leadership Academy Registration

Program Location: Virtual and In-Person

Question Title

* 1. If you would like your child to join this program, please provide the following contact information.

Parent/Guardian Name

Address

Address 2

City/Town

ZIP/Postal Code

Working Email Address

Working Phone Number

Question Title

* 2. Student 1 Information

Full Name

School

Address

Address 2

City/Town

ZIP/Postal Code

Grade

Email Address (if applicable)

Phone Number (if applicable)

Question Title

* 3. Student ID Number

Question Title

* 4. Your relationship to the student(s) being registered

Question Title

* 5. List student allergies

Question Title

* 6. Student(s) T-Shirt Size

Youth Small

Youth Medium

Youth Large

Youth XL

Small

Medium

Large

Other (please specify)

Question Title

* 7. Does the student have laptop and internet access?

Yes

Question Title

* 8. Do we have your consent to use images of your son?

Yes

Question Title

* 9. In consideration for my son participating in the Fayola Man Fall Leadership Camp, I agree not to hold Sims-Fayola Foundation, or any of its employees, liable for any claims.

Yes

Question Title

* 10. Does student have reliable transportation (Denver only)?

Yes

Question Title

* 11. FMLA sessions are held on Saturdays for at least 2 hours. Are you able to commit to attending at least 80% of the sessions?

Yes