Programs Registration Select ProgramSelect Program(s) *Apopka - Spring BreakApopka - Summer BreakApopka - Winter BreakAvalon Park - Youth Advisory BoardSouth Orlando - Spring BreakSouth Orlando - Summer BreakSouth Orlando - Winter BreakPlease select a program you'd like to register your child.Student InformationFirst Name *Middle NameLast Name *Email AddressGender *-MaleFemaleUnassignedDate of Birth *Ethnicity *-African American/BlackAsianCaucasian/WhiteHispanic/LatinoMiddle Eastern/North AfricanNative American/Alaska NativeMultiracialPacific IslanderOtherStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *School InformationName of School Attending *Grade Level *-1st2nd3rd4th5th6th7th8th9th10th11th12thStudent ID NumberSchool Lunch Status *-FreeReducedNoneMedical InformationPhysicians NamePhysicians Phone NumberSpecial Needs/Health Issues *-YesNoIf Yes, ExplainNeed Medication(s) *-YesNoIf Yes, ExplainParent/Guardian InformationFirst Name *Middle NameLast Name *Email Address *Phone *Employer NameEmployer Phone NumberRelationship To Child *-MotherFatherLegal GuardianAuthorized Pickup InformationFirst Name *Last Name *PhoneRelationship To ChildMy child has permission to sign themselves out the program. *-YesNoPolicy & WaiversRegistation Acknowledgment *Yes, I've read and agree with the registration acknowledgment.Photo Release AcknowledgementI release L.O.V.E. Our Youth, Inc. from any claim for invasion of privacy or use of my child and our likeness(es), and authorize the L.O.V.E. Our Youth, Inc. team to photograph, film, videotape and/or electronically record interviews with me/us, program members, guardian, or both, our appearance(s), photograph(s), voice(s), physical likeness(es) and name(s) in such manner as they see appropriate for the growth of the organizations mission and brand awareness. I further authorize L.O.V.E. Our Youth, Inc. and all other persons or entities participating in taking said photographs, films, videotapes and/or electronically recorded interviews to distribute now or anytime in the future, any or all of said photographs, films, videotapes and/or electronically recorded interviews to anyone including the general public, magazines, newspapers, television and radio stations, and/or any other organization or person that routinely presents information or news to the general public. No compensation shall be paid to me for such uses as described in this paragraph. L.O.V.E. Our Youth, Inc. shall own intellectual property and copyrights in all recordings, photographs, film, and videotape herein described above. I hereby grant and authorize L.O.V.E. Our Youth, Inc. the right to take, edit, copy, publish, distribute and make use of any and all pictures or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of and will not be returned.Register ChildSave as DraftPlease do not fill in this field.
