Youth Participant Registration Form

Program & Enrollment Information

Youth Participant Information

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Is the participant of Hispanic, Latino, or Spanish Origin?
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Grade (circle one)
Shirt Size (circle one)

Parent, Guardian and Emergency Contact Information

Contact 1

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Contact 2

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Contact 3

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Contact 4

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Youth Participant Waivers

Dismissal

By signing below, I will allow my child to walk home by themselves.

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Emergency Clause

In the event I cannot be reached in an emergency, I hereby give my permission to employees of the George L. Cannon II House of H.O.P.E Inc. to secure proper medical care for my child as deemed necessary. This permission extends from minor firstaid treatment to (under a doctor’s orders) hospitalization injections, anesthesia, and other medical procedures deemed.

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Media Release

I hereby grant permission to record my child’s/ward’s likeness and/or voice for use by television, films, radio or printed media to further the aims of George L. Cannon II House of H.O.P.E Inc. in related campaigns and magazine articles, booklets, posters and in any other ways they may see fit.

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Staff Alerts

Get Involved

We are Building Youth of Courage, Confidence, and Character who will make the world a better place. We work with young men & women between the ages of 13-24 years old.