Register-BGV Atlanta

Particpant's Information

Participant's Full Name

Participant's Date of Birth

Month

Day

Year

Participant's Age

Parent/Guardian Information

Parent/Guardian's Full Name

Parent/Guardian's Email

Parent/Guardian's Phone Number

Parent/Guardian's Address

Country/Region

Address

City

Zip / Postal code

Medical Information

Does your child take any medications?

Yes

I yes please specify

Emergency Contact Information

Emergency Contact 's Full Name

Phone

Relationship to Participant

Consent

I , hereby grant permission to BGV to take and use photographs of the attendee in connection with the Organization's activities. I understand that these photographs may be used in various forms of media, including but not limited to social media posts, websites, brochures, and promotional materials

I hereby acknowledge that participation in programs or events organized by Brown Girl Village is voluntary, and I agree that BGV, its staff, volunteers, and affiliates shall not be held liable for any injury, loss, or damage arising from participation in such activitieswith the Organization's activities. I understand that these photographs may be used in various forms of media, including but not limited to social media posts, websites, brochures, and promotional materials