Parent/Guardian Information

Please complete all fields below:

Parent/Guardian Full Name

Relationship to Participant

Phone *

Email *

Address

Home Address

City

State

Country

Postal code

Participant Information

Child's Full Name

Date of birth

School Name

Grade Level

Emergency Contact Information

In case of an emergency, please provide a secondary contact:

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Relationship to Participant

Additional Information

Medical Information

Photography Consent

I understand that photographs or videos of my child may be taken during workshop activities for promotional or educational purposes. I consent to the use of such media by Freepreneurs Organization for program promotion, education, and reporting purposes.

Authorization for Photography/Video Use (Optional)

Yes, I give my permission for my child's photographs/videos to be used.

No, I do not give permission for my child's photographs/videos to be used.

Parent Guardian Signature

I have read and understand the above information, and I give my consent for my child’s participation in the Purposely Fitted Bra Workshop.

By signing below, I, the undersigned parent/guardian of the above-named child, hereby give permission for my child to participate in the Purposely Fitted Bra Workshop hosted by Freepreneurs Organization. I understand that the workshop will include educational workshops on breast health, proper bra fitting, nutrition, exercise, and mental health to promote self-esteem and well-being. I acknowledge that participation in the workshop may involve discussions about health, body image, and self-care practices. I understand that my child may receive a properly fitted bra as part of the workshop, and all activities will be conducted in a respectful and supportive environment. I further authorize the workshop staff to secure any necessary emergency medical treatment for my child in the event of illness or injury during participation, and I agree to assume responsibility for any medical expenses incurred. I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from Freeprenuers, Inc. Message frequency varies. Message & data rates may apply. Text HELP to (561) 320-1002 for assistance. You can reply STOP to unsubscribe at any time.

Signature *

Clear

Date *