ADMISSION

Application

STUDENT NAME *

UPLODE A PICTURE OR PHOTO

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DATE OF BIRTH *

GRADE AND NAME OF SCHOOL *

MEDICAL NEEDS PLEASE EXPLAIN

CHILD'S FAVORITE SUBJECT *Math Science English/Writing Skills OTHER

PARENT/GUARDIAN *

I consent to the unrestricted use by Leading Ladies To Live (LL2L) or any person authorized by them of any photographs, recordings, interviews, videotapes motion pictures or similar visual or auditory recordings of my child. I understand that my child's image may be edited, copied exhibited, published or distributed by LL2L, and I waive the right to inspect or approve the finished product. Additionally, I waive any right to royalties or other compensation arising or related to the use of my child's image or recording. I also understand that this material may be electronically displayed via the internet or in public educational setting. There is no time limit on the validity of this release nor is there any geographic limitation of where these materials may be distributed.

We ask that every student treat each other with respect including, volunteers, and staff and mentors. Some examples of inappropriate behavior included, but are not limited to inappropriate physical/contact with others, inappropriate language, and verbal/physical threats of any kind. LL2L has zero tolerance to cyber bullying and bullying. We reserve the right to discontinue enrollment at anytime and there will be no refunds, transfers or exchanges.

DIGITAL SIGNATURE *

UPLODE SIGNATURE *

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Date *

I understand that this program is for a duration of 3 months and that there are no refunds, no transfers, no exchanges. *Agree

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