Living as Leaders: Leading in the Moment Participants's Name(Required) First Last Preferred Name Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grade in School(Required) 3rd 4th 5th 6th 7th 8th School(Required) Parent / Guardian's First and Last Name(Required) Parent/Guardian Email(Required) Enter Email Confirm Email Parent/Guardian Phone Number(Required)Email Address of the ParticipantPlease include the participant's email if the participant would like them to receive email communications in addition to the parent/guardian. Please list the first and last name of any individual who may pickup or drop off the participant. Shirt Size(Required)Register by October 5th to ensure a t-shirt is available in your size. T-shirts are limited and not guaranteed for those registering after October 5th. Youth Medium Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Additional InformationThe below information is optional and will be used for grant-writing purposes. Does the participant qualify for free or reduced lunch? Yes. No Section BreakConsent: Please check if you consent. I understand that the participant registered on this form will be participating in Living as Leaders by For a Real Change. By agreeing here, I understand that the photos taken during the program may be used for promotional purposes by For a real Change, Inc. I will review the consent waiver and sign upon agreeance.
