Youth First Name *

Youth Last Name *

School Name *

Youth Grade Level *

Youth Age *

Allergies (Type "N/A" if None) *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone *

Parent/Guardian Email *

I understand that photos and videos of my child may be taken during the I Am Me! Workshop for promotional and marketing purposes on social media, websites, and printed materials. By checking the box, I acknowledge and give permission for Hope Mills Prime Movers and Brandon McLean to use these images.