Ballers Conference Registration

Baller's Conference Registration Form 2024

Student(s)

Student First Name *

Student Last Name *

Student Date of Birth *

Current Grade *

Student Gender *

Student Email

Student Mobile Phone Number

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Parent First Name *

Parent Last Name *

Home Phone Number *

Mobile Phone Number *

Email Address *

Home Address

Parent Consent

Completing this registration confirms that my child will be in attendance July 27, 2024. If my student is no longer able to attend I will email carmen@icementors.org at least 2 weeks prior to the event. I am the parent or legal guardian of the child/youth/children named above, and grant consent for their attendance at ICE Mentors programs. I also grant ICE Mentors my permission to use the child/youth/children likeness in photographs for any legal use, including but not limited to: publicity, copyright purposes, advertising, and web content.

Parent Signature *

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Ballers Conference Registration

Student(s)

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