MDT 2024 Student and Parent Registration

By checking this box, I consent to be contacted for reasons relating to the event for which this application is intended. I understand that contact may be made by phone, mail or email. I acknowledge that attendance with a legal guardian is required to participate in the activities of Power UP: It's a mother-daughter thing! *

check to acknowledge

PARENT / GUARDIAN - COMPLETE THIS SECTION

Parent / Guardian's Name*

First Name

Last Name

Parent / Guardian's Signature and Date*

[clear]

Use your mouse or finger to draw your signature above

Parent / Guardian's Phone Number*

Parent / Guardian's Email*

Media Release Authorization Signature - Parent Signature, Child's Name, Date*

[clear]

RELEASE FORM Consent Form For The Use Of Photographs And Videos (parents, guardian, children) Power UP Inc. recognizes the need to ensure the welfare and safety of all individuals taking part in all activities associated with our organization. In accordance with our Child Protection Policy, we will not permit photographs, videos or other images of young people to be taken without the consent of the parents/guardians and the child. As your child will be taking part in a Power UP Inc. event we request your consent to take photographs/videos of the event or activity that may contain images of your child/you. It is likely that these images may be used for the following purposes: • a record of the activity or the event • in a written evaluation report of the activity or event that will be viewed by Power UP Inc. and its Board of Directors • publicity material for future activities or events on advertisement materials • illustrations of the activities or events in published articles • future grant applications It is also likely that any materials or documents created by your child/you while participating in Power UP Inc. activities may be used in the future. Power UP Inc. will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform Power UP Inc. immediately. No compensation will be given for the use of any images of your child/you. I consent to Power UP Inc. photographing or videoing as he/she will be taking part in the Power UP Inc. event.

ALL PARTICIPATING STUDENTS INFORMATION MUST BE COMPLETED

[For Participating Students 6th to 12th Grade]

Student's Name*

First Name

Last Name

Student's Date of Birth*

Student's Phone Number

Student's Email*

Student's Address

Address Line 1

Address Line 2

City

State

ZIP Code

Media Release Authorization Signature - Parent Signature, Child's Name, Date*

[clear]

RELEASE FORM Consent Form For The Use Of Photographs And Videos (parents, guardian, children) Power UP Inc. recognizes the need to ensure the welfare and safety of all individuals taking part in all activities associated with our organization. In accordance with our Child Protection Policy, we will not permit photographs, videos or other images of young people to be taken without the consent of the parents/guardians and the child. As your child will be taking part in a Power UP Inc. event we request your consent to take photographs/videos of the event or activity that may contain images of your child/you. It is likely that these images may be used for the following purposes: • a record of the activity or the event • in a written evaluation report of the activity or event that will be viewed by Power UP Inc. and its Board of Directors • publicity material for future activities or events on advertisement materials • illustrations of the activities or events in published articles • future grant applications It is also likely that any materials or documents created by your child/you while participating in Power UP Inc. activities may be used in the future. Power UP Inc. will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform Power UP Inc. immediately. No compensation will be given for the use of any images of your child/you. I consent to Power UP Inc. photographing or videoing as he/she will be taking part in the Power UP Inc. event.

Participating Student's Shirt Size [grades 6th - 12th]*

Small Medium Large X-Large XX-Large

Adult sizes

Student's School Name*

Student's Grade*

6th 7th 8th 9th 10th 11th 12th

How did you hear about this event?*

Friend or colleague Search Engine Advertisement Power UP Representative

Other:

STUDENT POWER UP ESSAY FORM

[participating students Grades 6th - 12th can enter for a change to win prizes!]

Please select one question below and write a one or two paragraph essay.

Given that there is a workforce shortage of women in construction, do you think you would be interested in a career in construction? Explain why or why not What does construction do for America? In your own words, explain what types of things you think a female construction worker does. In your own words, explain what you think the life of a female construction worker is like.

Long Answer

[optional] STUDENT DEMOGRAPHIC INFORMATION The purpose of providing and collecting information on this application is for demographic tracking for nonprofit funding. The information provided here will be kept confidential.

Participant's Race

White or Caucasian Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other

Participant's Gender

Male Female

Participant's Household Parental Status

1 Parent Household 2 Parent Household Other

Household Income

Household income below $35,000 annually Household income between $35,000 - $55,000 annually Household income between $55,000 - $70,000 annually Household income between $70,000 - $85,000 annually Household income between $85,000 - $100,000 annually

Household receives federal, government or public financial assistance

Yes No

WWW.POWERUPLOUD.ORG