Guardian Name *

First Name

Last Name

Participant Name *

First Name

Last Name

Photo Release *

I agree to let CLR Academy, The Mighty Oak Project and all of its related partners use our child's image and likeness (in addition to ours).

I Agree

Do Not Agree

Injuries *

I understand due to the nature of activities, the youth participant I am responsible for may be injured or harmed in these activities for which CLR Academy and its partners are not liable or responsible in any regard.

I Understand

I Do Not Understand

Emergency Contact *

In case of emergencies, let us know who to contact.

First Name

Last Name

Emergency Contact Phone *

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