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Community Service Hours (9-14-24)

Saturday, Sept. 14 - Beyond Pain Program @ Miller Library

This registration MUST be completed by a parent/guardian for anyone under 18 years of age.

For middle or high school students to receive community service hours, 1) student must be a Howard County student, 2) student must attend the entire event and fully participate, and 3) student must sign in/out at the event. Thank you.
1.Student's first name(Required.)
2.Student's last name(Required.)
3.Parent/Guardian's full name (Again, this registration MUST be completed by parent/guardian)(Required.)
4.Will you or another adult be attending with your student?
5.Email address of parent/guardian(Required.)
6.Re-enter parent/guardian email address(Required.)
7.Phone number of parent/guardian(Required.)
8.(optional) If different, phone number of student
9.(optional) Email to contact student
10.If student is in high school, which school do they attend? If in middle school, please skip to the next question.
11.If student is in middle school, which school do they attend?
12.Grade?(Required.)
13.THIS EVENT IS OPEN TO THE PUBLIC. PHOTOS, ETC., MAY BE RELEASED.

Participation Waiver for Parents/Guardians

By submitting this registration and as the parent and/or legal guardian of this youth/student, I agree to this waiver(s):

I have read this waiver and knowing the facts, I, for myself and anyone entitled to act on my behalf, waive and release HC DrugFree and its employees, directors, officers, partners, agents, and sponsors from and against all claims, demands or causes of actions for accidents, personal injury, bodily injury, death, property damage or other injury or loss or damage of any kind, occurring from any cause arising from or related to or in connection with named participant’s involvement in the event named above.

Further, I grant permission to all of the foregoing to use named participant’s photographs, audio and audio visual recordings or any other record of this event for any legitimate purpose.

I understand that it is my responsibility to IMMEDIATELY report any injury or concerns to HC DrugFree’s Staff or Board Member present at this event AND to notify Staff at the Library.(Required.)
14.Thank you for completing this registration.