HBCU Registration Form

First Name

Middle Name

Last Name

Home Address

Apartment

City

State

Zip Code

Sex

DOB

Cell Phone

Student’s Email

High School Attending

Address

Grade

Counselor

Cumulative GPA

Shirt Size

Are you Currently involved or have been involved in school Activities?

If Yes, Please List

List Area(s) of Study you are Interested in Pursuing

Parent First Name

Parent Last Name

Parent Address

City

State

Zip Code

Parent’s Cell Phone

Parent’s Email

Date

I hereby declare that all the above information furnished is true to the best of my knowledge and belief

CANCELLATION & REFUND POLICY FORM

Cancellation and Refund Policy: Due to changes in contracting with airlines, charters, and hotels, Kids 1st Foundation will not provide refunds for ANY REASON for the Tour unless the Tour is canceled prior to departure. However, you have the option to transfer deposit(s) to a new registering participate or receive a credit for a future tour. By registering I acknowledge that I have read and agree with the cancellation and refund policy for the Kids 1st Foundation HBCU Making Moves Tour.

Student Signature

Age

Date

Parent/Guardian Signature

Age

Date

* BY SIGNING ABOVE, I HEREBY CERTIFY that I am the parent and/or legal guardian of the participant listed above.

TOUR RELEASE AND ASSUMPTION

Please Read Before you sign

I do hereby give my permission to participate in the HBCU Making Moves Tour presented by Kids 1st Foundation. I understand that all precautions will be taken to ensure his/her safety.

I am aware that certain dangers may occur, including but not limited to the hazards of accidents or illness in places without medical facilities, hazards created by the forces of nature, and hazards of traveling by air, bus, automobile, and other means including walking.

In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical, dental diagnosis or treatment and hospital care considered in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of a member of the medical staff of the hospital or the facility furnishing medical or dental services.

Kids 1st Foundation acts only in the capacity of an organizer. Its volunteers, are not agents of the suppliers of travel services and accommodations, and are not liable for any claims, suits, actions, delays, inconveniences, injuries, or any other expenses of any kind or any nature, caused by any other company providing travel services or accommodations.

I understand and do hereby assume all of the above mention risks and will hold Kids 1st Foundation and its representatives, harmless from any and all liability whatsoever, which may arise out of or in connection with the participation in activities arranged by this organization. The terms thereof shall serve as a release from assumption of risk for their Directors, Administrators, Volunteers and Chaperones.

Parent/Guardian:

Parent Name:

Signature:

Date

Email:

Address:

City:

State:

Zip:

Telephone: (Home):

Work:

Cell:

Student Signature:

DOB:

Student’s Phone:

Student’s Email:

(This information will only be shared in an emergency situation)

AUTHORIZATION FOR EMERGENCIES

A representative from Kids 1st Foundation will notify you if your child is ill, injured, or misbehaving. If you cannot be reached, your child will be taken to the nearest emergency hospital or facility providing medical or dental services. If your child is seriously misbehaving, he/she will be taken to the nearest airport and sent home at your expense.

I am

parent/guardian of

SS#

hereby authorize Kids 1st Foundation and its representatives to seek and authorize any and all emergency medical services and behavioral interventions needed for my child. This authorization is effective from departure on Tuesday, March 14, 2023 through the return on Sunday, March 19, 2023.

MEDICAL HISTORY INFORMATION

Information requested below is mandatory and confidential and will only be shared with appropriate representative(s) of Kids 1st Foundation

My child is taking the following medications:

Dosage

My child is not taking any medications

My Child is allergic to Peanut products

Yes No

My Child is allergic to Shellfish (List type)

Medical Insurance Carrier:

Medical Insurance or Group Number:

Address:

Phone:

Personal Physician

Parent/Guardian Signature:

(This information will only be shared in an emergency situation)

EMERGENCY TELEPHONE CONTACT:

Name

Relationship:

Phone: (H)

Phone: (W)

Cell:

Name of additional contact:

Relationship:

Phone: (H)

Phone: (W)

Cell:

RULES AND REGULATIONS

**PLEASE READ Before you sign**

The following rules and regulations will apply to all students. We expect all students to behave in an appropriate manner. Rules and regulations governing students enrolled at each university, as well as the rules listed below will be strictly enforced.

Students who fail to comply with the rules and regulations will be sent home at the expense of their parents.

Students are expected to show consideration and respect for their fellow students, chaperones, tour leaders, tour guides, campus staff, bus drivers, and hotel & restaurant personnel. Disrespectful and rude behavior, actions, language (all profanity), or gestures will not be tolerated.
Possession and/or use of alcoholic beverages and drugs (including Vape, Wax, and/or Dab Pen’s) other than those drugs prescribed by a doctor are absolutely forbidden and will result in your child being SUSPENDED from the Tour and returned to you at your expense.
No weapons of any kind are allowed on this tour.
Kids 1st Foundation WILL NOT BE RESPONSIBLE FOR ANYONE INVOLVED IN ANY ILLEGAL ACTIVITIES. ANY ONE ARRESTED WILL BE DROPPED FROM THE TOUR GROUP. ANY LEGAL EXPENSE OR other EXPENSES REQUIRED TO RETURN TO CALIFORNIA WILL BE THE RESPONSIBILITY OF the STUDENT AND PARENTS/GUARDIAN.
No one will be allowed to leave the tour to visit relatives or friends.
Students will not attend off campus activities or ride in cars belonging to college students.
ABSLOUTELY no cell phone use during Campus Tours or Cultural Visits.
Males are prohibited from wearing Sagging pants, headgear of any type inside of buildings, and clothing that exhibit obscene or controversial slogans or advertising.
Females are prohibited from wearing crop tops, strapless, low-cut clothing, clothing with high slits, tops and outfits that provide minimum coverage and clothing that exhibits obscene or controversial slogans or adverting.
No going back to bus for any reason. Driver will not open any parts of the bus in order for you to get whatever you feel you need at the time, or for you to just sit/sleep on the bus. The Driver is not responsible for you unless he/she is driving; otherwise the Driver is off work. If you think you need it, take it with you.
Dress in regular clothes when traveling. Do not wear pajamas, bonnets or house shoes on the airplane or while on tour of the College Campus.
Curfew is at 10:00pm and will be STRICTLY ENFORCED. There will be no visiting other rooms, opening doors, getting ice or ordering food for delivery.
Participants will stay in hotels in Atlanta, Birmingham and Montgomery. There will be other guests in the hotel. Therefore, appropriate noise levels are required.

Student Signature

Age

Date

Parent/Guardian Signature

Date

* I hereby declare that all the above information furnished on all the above forms is true to the best of my knowledge and belief

LIST OF ITEMS TO BRING ON THE TOUR

Please bring one piece of luggage to check free on Southwest. You are allowed two carry-on pieces.
Luggage checked on Delta will cost YOU.
Pack a collapsible and/or expandable bag to carry items you purchase or receive during the tour
Toiletries.
Money: Bring enough money to buy food and souvenirs for six days. (Suggested $400.00).
Late-night snacks should be purchased during the day. There will be no transportation available to go to local stores and restaurants.
Do not buy souvenirs in the airports. (Too expensive).
Souvenirs purchased in the Campus Book stores are also expensive.
Consider bringing a cellphone charger and an extra cord (if you are known for losing one).

HBCU Registration Form

CANCELLATION & REFUND POLICY FORM

TOUR RELEASE AND ASSUMPTION

Parent/Guardian:

AUTHORIZATION FOR EMERGENCIES

MEDICAL HISTORY INFORMATION

EMERGENCY TELEPHONE CONTACT:

RULES AND REGULATIONS

LIST OF ITEMS TO BRING ON THE TOUR

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