Registration Type

School

Primary School Contact First Name

Primary School Contact Last Name

Phone Number

Email

Primary Contact Title/Position

Approximate Number of Chaperones Attending (Final Numbers Will Be Submitted Closer To Event)

Approximate Number of Students Attending (Final Numbers Will Be Submitted Closer To Event)

Grade Levels Attending (Check all that apply)

FreshmenSophomoresJuniorsSeniors

What mode of transportation will be used for event?

E-Mail and Texting Disclaimer

By checking this box, I allow/consent the Be A Leader Foundation to send text messages to the mobile phone and e-mail provided to convey information and updates regarding the 2024 Taking Steps Towards College Success Summit event, future college going programs and other important program information from affiliated partners and collaborators.

Photographic Release/ Waiver and Release of Claims:

By checking this box, I give my full consent and permission to the Be A Leader Foundation, its sponsors and corporate sponsors, their successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this event (the “Event”). I understand that my consent to these provisions is given in consideration for being permitted to participate in this Event. I am a voluntary participant in this Event, and in good physical condition. I know that this event is a potentially hazardous activity and I hereby voluntarily assume full and complete responsibility for, and the risk of, any injury or accident that may occur during my participation in this event or while on the premises of this event. I, for myself, my next of kin, my minor children that attend the event, my heirs, administrators, and executors, hereby release and hold harmless and covenant not to file suit against The Be A Leader Foundation, its affiliates and any affiliated individuals, any event sponsors and their agents and employees, and all other persons or entities associated with this event (collectively, the “releases”) for any injury or damages I might suffer in connection with my participation in this event or while on the premises of this event, including but not limited to, personal injury or damages suffered by me or others, whether such losses, liabilities, or claims be caused by falls, contact with and/or the actions of other participants, contact with fixed or non-‐fixed objects, contact with animals, conditions of the premises of the event, negligence of the releases, risks not known to me or not reasonably foreseeable at this time, or otherwise. This Photographic Release and Waiver and Release of Claims (collectively, the “Release”) shall be construed under the laws of the state in which the Event is held. I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.