STUDENT REGISTRATION

The goal of this registration is to collect data to better serve the youth and families in our service areas. The data will also assist us when applying for and/or writing grants, seeking sponsorships, donations and more to achieve our fundraising goals to continue to elevate our mentoring programs.

This will be annual occurrence to make sure we have the most current information for the families we serve.

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Privacy Notice: Your information will not be shared with the public nor sold to businesses and/or individuals for the duration of the existence of Legacy Driven Foundation, Inc.. It is only for the use of furthering our mentoring initiatives and will remain within the organization to be used by our board members and/or donor and fundraising management team.

Note: This website and the pages within are secure by SSL and encryption.

Student Registration & Parent Survey

PARENT DEMOGRAPHIC SURVEY:

Parent Name:

First

Last

Home Address:

Email:

Primary Phone:

Age:

Ethnicity:

Household Income:

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

If attended, what is the name of your post-secondary school(s)?

Please list all schools.

Marital Status:

How many children do you have in our program?

Do you plan to relocate (timeframe)?

How many total children are in your household?

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

Yes

Prefer Not To Answer

Would you like to volunteer with Legacy Driven?

If you answered YES as a Parent Volunteer, what area do you have an interest or expertise in that could assist us?

STUDENT REGISTRATION:

Youth Name (1st)

First

Last

Mentoring Program Type?

Girls – Ladies of Legacy Driven

Boys – Driven Young Men

Both

Youth Age (1st)

Grade Level (1st)

School Name (1st)

T-shirt Size (1st)

Youth Name (2nd)

First

Last

Youth Age (2nd)

Grade Level (2nd)

School Name (2nd)

T-shirt Size (2nd)

Emergency Contact Name

First

Last

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.

STUDENT REGISTRATION

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