Participant's Full Name *

Participant's Age *

Participant's Date Of Birth *

Please list the participants MOST FREQUENTLY USED email address (Recommendation: Please list their personal email address. If they don't have one, we recommend them getting one) *

Please list the participants cell phone number *

Any allergies or medical concerns *

Hobbies and Interests *

What leadership opportunities has he been in and/or is currently a part of? *

Address

Street Address *

City *

State *

Country *

Postal Code

Parent/Legal Guardian Name *

Relationship to applicant *

Parent/Legal Guardian Name #2 *

Relationship to applicant *

Phone *

Email *

Emergency Contact information *

Emergency Contact information 2 *

Emergency Contact information 3 *

Media Release Form

J&J Leadership Academy Incorporated wants to showcase what we do with the young males in our program. We need your assistance to be able to do this. Please read below, sign and date:

I authorize J&J Leadership Academy Incorporated to photograph my child, take video footage of my child, and make electronic sound recordings of my child.

I authorize the use of photography or electronic reproductions of my child for any purpose, including but not limited to, educational and other public media purposes deemed appropriate by J&J Leadership Academy Incorporated.
BY SIGNING THIS FORM, I AGREE TO THESE ABOVE-MENTIONED TERMS to edit this text

Parent/Guardian's Name #1 *

Parent/Guardian's Name #2 *

Date *

School Connection & Release Form

At J&J Leadership Academy Incorporated, we believe that education is key and important in the development of our young males. We are committed to seeing and investing in our young males to succeed in and outside the classroom.
  
INTERIM REPORTS & REPORT CARDS WILL BE VIEWED ON A REGULAR BASIS! 
Please read the information below:

I authorize J&J Leadership Academy Incorporated to obtain any needed educational information from my child’s school such as academics, attendance, behavioral records along with any conversation information with teachers, counselors, and administrative staff. 

I also authorize the program to perform any additional informational and data collection of my child for program assessment and evaluation purposes. 

BY SIGNING THIS FORM, I AGREE TO THESE ABOVE-MENTIONED TERMS

Participants Name *

Participant's Schools *

School Counselor Name & Contact Number *

Parent/Legal Guardian Name. *

Current Date *

FIRST-TIME PARTICIPANTS, PLEASE COMPLETE THIS SECTION

In your own words, describe what a leader is to you? Why do you want to be a part of J&J Leadership Academy Incorporated?

CURRENT/RETURNING J&J MEMBERS, PLEASE COMPLETE THIS SECTION

As a current/returning member of J&J Leadership Academy Incorporated, please express how this program has positively impacted your life.