Butts County - Adult Digital Literacy Workshop - August 18, 2026 -- REGISTRATION

Thank you for your interest in our upcoming workshop! 

This registration form should be completed by the adult who is planning to attend the workshop. 

You will know that your registration has been completed successfully, and you have a spot reserved in the workshop when you click "done" after the last question and see the message that begins with "SUCCESS" - your registration is complete!"
This indicates to you that you have reserved your spot in our workshop on Tuesday, August 18, 2026.

Please plan to take a screen shot of that message so you have confirmation for your records. 

Reminders – 

Date: Tuesday, August 18, 2026
Time: Check-in begins at 9:30AM. Please plan to arrive in time to check in by 9:45AM in order to be ready for the workshop to begin promptly at 10:00AM If you do not arrive by 9:45AM, your spot in the workshop and your laptop may be forfeited and reassigned to someone on our walk-in/wait list.

Location: Butts County Extension Office (inside the Recreation Department)
576 Ernest Biles Dr. Jackson, GA 30233.

Questions? Call or text us at (404) 496-8581 or email us at program@iuatl.org 

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* 1. Name of Adult who will attend the workshop

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* 2. Email Address

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* 3. Phone Number (cell preferred)

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* 4. YEAR of birth

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* 5. Current age range

Under 20

20-29

30-39

40-49

50-59

60-69

70 or older

I prefer not to answer

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* 6. Gender

Female

Male

Non-Binary

Other

I prefer not to answer

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* 7. Ethnicity/Race

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latinx

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Multi-Racial

I prefer not to answer

Other (please specify)

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* 8. Language Spoken Most Often at Home

English

Spanish

I prefer not to answer

Other (please specify)

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* 9. Complete Address of Your Residence

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* 10. What county do you live in (Example: Butts)

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* 11. Highest Level of Formal Education

Completed some High School

Earned a High School Diploma, GED, or Equivalent

Completed a Technical School Certification or Career/Job Training Program

Completed some College

Earned a College Degree

I prefer not to answer

Other (please specify)

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* 12. Annual Household Income (combined total for your household)

$10,000 or less per year

$10,001 - $20,000 per year

$20,001 - $25,000 per year

$25,001- $35,000 per year

$35,001 - $50,000 per year

$50,001 - $75,000 per year

$75,001 - $100,000 per year

More than $100,000 per year

I prefer not to answer

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* 13. Do you or any member of your household receive assistance through a government program such as SNAP, TANF, free/reduced lunch, and/or Medicaid?

Yes

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* 14. Have you, or anyone who currently lives in your household, ever served in any branch of the United States military?

Yes

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* 15. How many Adults are in your household?

More than 5

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* 16. Are you the parent/guardian/caregiver of any children age 0-17?

Yes

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* 17. How many children (ages 0-17) live in your household?

More than 5

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* 18. How many working computers (desktop, laptop, or tablet) are currently in your home? Please include both those you own and those that may be on loan to you from a school and/or organization.

None

More than 3

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* 19. Of the computers in your home, how many do you/your family own?

There is not a computer in my home.

I/my family DO NOT OWN any of the computers in my home.

I/my family OWN SOME OR ALL of the computers in my home.

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* 20. What type of Internet access do you currently have in your home?

NO Internet access at my home

Internet access only from a cell phone

Internet access through broadband, fiber, or cable provider (examples: Comcast, Xfinity, AT&T, etc) or other/ unsure of the type

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* 21. INSPIREDU CONTRACT AGREEMENT FOR TRAINING AND DEVICE OWNERSHIP

Inspiredu is pleased that you would like to receive computer equipment, the “Equipment”; installed and online software, the “Software”; and related services, including without limitation: training, internet enrollment information, and help desk services, the “Services” as part of Inspiredu programs.

To participate in Inspiredu programs and receive the Equipment, the Software, and the Services, you must agree to the below terms and conditions.

a. Ownership - The Equipment, but not the Software, will automatically become yours after successfully complying with the terms of this contract. You do not own the Software, but you may use the Software so long as you use the Equipment in compliance with the terms of this agreement. You must complete the entire digital skills workshop in order to earn the Equipment.

b. Use of Equipment and Software - You will not destroy, discard, sell, or otherwise dispose of the Equipment, or lend or rent the Equipment to any person. Your rights to use the Software are subject to license agreements from the companies that provided the Software to Inspiredu. You will not make any copies of any of the Software, or transfer any of the Software to any other person, or otherwise violate the terms of the end‐user license agreements that apply to the Software. If you ever transfer the Equipment to any other person, you must delete from it all of the Software. The Equipment and the Software shall be used by you in a manner that does not violate any laws, ordinances, regulations, or rights of any other individual and in a manner that complies with all Inspiredu recommendations for their proper use.

c. Condition of Equipment and Software - Inspiredu makes no representation or warranty of any sort with regard to the Equipment, the Software, or the Services. Inspiredu has no obligation to repair or replace the Equipment or the Software; rather, you are solely responsible for the Equipment and its use and its condition from the day you receive it. It will be your responsibility to protect the Equipment and the Software against damage, theft, and loss.

d. Release and Waiver - Neither Inspiredu nor any of the persons or entities who donated, funded, or otherwise provided or facilitated the provision of any Equipment, Software, or Services to Inspiredu or you or who are otherwise involved in planning, coordinating, delivering, or hosting the Inspiredu Programs & Services “Third Parties” will be responsible for any claim, liability, or damage including without limitation any claims for bodily injury or death to persons or damage to property arising out of your receipt, ownership, use, or disposition of the Equipment, the Software, or the Services. You release Inspiredu and Third Parties from, and waive, any claim of that sort and agree you will not assert any claim against Inspiredu or Third Parties arising out of your receipt, ownership, use, or disposition of the Equipment, the Software, or the Services.

e. Cancellation and Revocation - Failure by you to comply with each of the terms set forth above that you have agreed to will result in the cancellation of this agreement and revocation of your right to use the Equipment and the Software and to receive the Services. If you do not complete the digital skills workshop in its entirety, you may be asked to forfeit the Equipment upon your departure.

YES --- I agree to the terms and conditions outlined in the Inspiredu contract. (You must click in the box to accept these terms. A check mark will appear once you click.)

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* 22. LEARN TO EARN AGREEMENT -- I understand that I/my family must complete the digital skills workshop in its entirety to earn the laptop. An individual/family who does not complete the entire workshop may be asked to forfeit the Equipment (laptop/tablet and all accessories) upon an early departure.

Yes - I understand the "Learn to Earn" policy. (You must click in the box to indicate your acknowledgment. A check mark will appear once you click.)

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* 23. EMAIL/PHONE/TEXT AGREEMENT -- Inspiredu uses the email address and/or phone number you provide at registration to send reminders of your upcoming workshop and ask you to confirm your attendance. We will also send an email to you after you attend.

NOTE: You do have the option to opt out of email and/or text messages by notifying us of your wish to do so upon your first receipt of either/both.

Yes - I understand the "Email/Phone/Text" policy, including the process for opting out. (You must click in the box to indicate your acknowledgment. A check mark will appear once you click.)

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* 24. MEDIA RELEASE AGREEMENT -- Inspiredu takes pictures and videos at our workshops for external marketing such as our social media channel and our website or reports that are shared with our funders. The photos, videos, or other materials to be used by Inspiredu do not include personal information such as name, address, phone number, etc.

Please read the following consent:

I am over 18 years of age, and I have the authority to grant this consent for myself and all family members attending this workshop with me today. By clicking the "Yes" button below, you acknowledge that you have read and agree to be bound by Inspiredu's Privacy Policy and the Media & Interview Release, each of which may be updated from time to time and effective on the date posted.

NOTE: You do have the option to opt out of pictures/videos for yourself and your family. If you wish to do so, it is your responsibility to notify an Inspiredu Staff member of your preference to opt-out of pictures/videos on the day of the workshop and sign an "opt-out" statement at that time.

Yes - I understand and agree to Inspiredu's Privacy Policy and Media & Interview Release, including the process for opting out of photos/videos. (You must click in the box to indicate your acknowledgment. A check mark will appear once you click.)

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* 25. Please type the FIRST and LAST NAME of the ADULT who is providing the above consent. By typing your name here, it serves as the electronic signature for the purposes of agreeing to the terms and conditions of the Inspiredu contract for you/your family to receive a laptop, the Learn to Earn policy, the Email/Phone/Text policy, the privacy policy, and the Media Release policy. (Note: Only persons 18 years old or older are authorized to sign this contract.)