Registration

PARENT DEMOGRAPHIC SURVEY:

* denotes a required field for data purposes

Parent Name:

First Name

Last Name

Home Address:

Email:

Primary Phone:

Age Range:

Ethnicity:

Education Level:

Some high school, no diploma

High school diploma or GED

Some college credit, no degree

Associate (2-year) degree

Bachelor’s (4-year) degree

Master’s degree

Doctorate degree

Marital Status:

How many total children are in your household?

Have you participated in a fundraiser and/or donated personally to Legacy Driven since 2018?

Yes

No, but I am interested in more information.

Would you like to volunteer with Legacy Driven?

If you answered YES to the above questions, what area do you have an interest or expertise in that could assist us?

YOUTH REGISTRATION:

Youth Name

First Name

Last Name

Mentoring Program Type?

Young Ladies

Youth Men

Both

Youth Age

Birth Date

Grade Level

School Name

T-shirt Size

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

Emergency contact relationship to child?

List any allergies and/or medications that would be needed after-school.

(i.e. nuts, shellfish, type of plants, inhaler etc)

Additional Information about your child(ren) that will assist us while mentoring him/her/them?

Legacy Driven Foundation, Inc. General Liability & Release Waiver:

Parent/Gaurdian, the SIGNER of this REGISTRATION FORM which includes immediate & extended family, “Releases” Legacy Driven Foundation Inc., Any/All Schools within, Gwinnett County Public School System, other participants, officers, directors, agents, other staff from any/all liability for said YOUTH(s) registered for this event and all other’s under the organization of Legacy Driven Foundation, Inc..‎

It is the purpose of this agreement to exempt, waive and relieve “Releases” from any and all liability for personal injury including re-injury from a past injury, property damage, wrongful death, including if caused by negligence, including the negligence, if any, Releases.‎

I recognize that there are certain inherent risks associated with the activity of PHYSICAL FITNESS TRAINING, SPORTS ACTIVITIES and I assume full responsibility for personal injury to child(ren) including myself, and (if applicable) other family members if participating in inside/outdoor activities, and further release and discharge Legacy Driven Foundation, Inc and above mentioned entities, and any related/associated businesses or other third parties.‎

I give Legacy Driven Foundation, Inc. full AUDIO, PHOTO & VIDEO permission for your youth and/or adults during any Sessions to be recorded. Please note that AUDIO, PHOTO and/or VIDEO may be posted on our social media and/or website channels at any given time.‎

I give Legacy Driven Foundation, Inc. full access to my child(rens) school related data including but, not limited to PBIS(Positive Behavioral Interventions and Supports), academic, behavioral and attendance records for qualitative & quantitative purposes to better understand and serve my student(s).‎ (Note: This data will not be shared outside of Legacy Driven Fdn.)

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT fully. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.‎

If you are human, leave this field blank.

My Shopping Cart

DATA COLLECTION/PRIVACY NOTICE

The goal of this registration is to collect data to assist us when applying for and/or writing grants, seeking sponsorships and more from a variety of sources to achieve our annual fundraising goals to continue to elevate our mentoring programs.

MENTORSHIP FEES

We ask that each household donate $50 per student or more for services provided for the academic year.

Note: Your may donate in two installments of $25, but we ask that it be complete within 30 days.

The registration application process will be an annual occurrence to ensure we have the most current information for the families we serve.

PARENT DEMOGRAPHIC SURVEY:

YOUTH REGISTRATION:

2025 LEGACY FUNDRAISING CAMPAIGN

SCAN OUR QR CODE TO GIVE!

legacydrivenyouth