Winter Youth Development Exchange Registration Form

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1. Name (Required.)

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2. Email (Required.)

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3. Phone (optional)

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4. Zip Code (Required.)

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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? (Required.)

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: (Required.)

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. (Required.)

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12. Date (Required.)

Date

Winter Youth Development Exchange Registration Form

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* 1. Name (Required.)

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* 2. Email (Required.)

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* 3. Phone (optional)

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* 4. Zip Code (Required.)

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* 5. Gender

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* 6. What race are you?

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* 7. What grade are you in? (Required.)

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

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* 9. How did you hear about this event?

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* 10. Acknowledgements: (Required.)

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

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* 12. Date (Required.)

1. Name (Required.)

2. Email (Required.)

3. Phone (optional)

4. Zip Code (Required.)

5. Gender

6. What race are you?

7. What grade are you in? (Required.)

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

9. How did you hear about this event?

10. Acknowledgements: (Required.)

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

12. Date (Required.)