Dueña de mi futuro Registration Participants's Name(Required) First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grade in School(Required) 6th 7th 8th 9th 10th 11th 12th 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 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. Will the participant be driving themselves?(Required) Yes. My teen will drive themselves. No. My teen will be brought to the program. Dueña de mi futuro takes place over eight Saturdays during the school year. They are October 21, October 28, November 4, November 11, February 17, February 24, March 2, and March 9. We encourage youth to participate each Saturday. Please let us know if there are any dates that your teen WILL NOT be present. Shirt Size(Required) Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL What is the academic or career field interest of your teen? Registration Fee: The registration fee is $20 for the academic year. Please let us know your preferred method of payment.(Required) We will send $20 via Cash App $forarealchange We will send $20 via Venmo @forarealchange We will bring $20 on the first day, October 21. Additional InformationThe below information is optional and will be used for grant-writing purposes. Did either parent of the participant graduate from a four-year college? Yes No Does the participant qualify for free or reduced lunch? Yes. No Section BreakPlease tell us more about your teen.Please let us know if you teen has any special dietary or assessibility needs. Please let us know if your teen is academically advanced or has any learning challenges. Consent: Please check if you consent. I understand that the participant registered on this form will be participating in Dueña de mi futuro 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., the Hispanic Organization for the Promotion of Education, WKU, and SKYCTC. On the first day, I will review the consent waiver and sign upon agreeance.