Chill Foundation Alumni Registration

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Contact Type

1. Chill

Last Year Participated in as a Youth (i.e 2012)

Chill Site

Is there anything you'd like to tell us about your time with Chill?

Do you currently volunteer with Chill?

YesNoNo, but I'd like too in the future

2. Contact Information

First Name

Last Name

Birthdate

example: 01/18/1994

Your Age

Mobile Phone

input format: 123-456-6789

Instagram Handle

Optional

The Race and/or Ethnicity I identify with:

Only reported in aggregate, optional!

Address Line 1

City

Country

State

Provinces

State/Province

Postal Code

6. Chill Foundation Email List

By checking this box, you agree to recieve emails from Chill Foundation. You may unsubscribe at any time.

YesNo Thanks

7. Media Waiver

I hereby irrevocably release, consent and allow Chill Foundation and its Sponsors to use my/my dependent’s photographs/likeness/voice, as it pertains to participation with Chill Foundation programs, in any manner for promotional efforts without expectation of any reimbursement in connection with its use.

I have read the above and choose

YES, I DO allow the Chill Foundation to use my/my dependent's photos. NO, I do NOT allow the Chill Foundation to use my/my dependent’s photos.

You must be 18 in order to legally sign for yourself and finish this registration.

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