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Elevate Bridgeport

Fit Fam Summer Youth Program

July 7th through August 7th

Monday through Thursday 10am to 2pm

Student's Full Name*

Student’s Last Name*

Student's Phone Number*

Student's email*

Address

Parent / Guardian Full Name*

Parent / Guardian Phone Number*

Parent / Guardian email*

Emergency Contact Full Name*

Emergency Contact Phone Number*

What school do you attend?*

What grade are you in?*

I hereby grant Elevate Bridgeport permission to use the above student's likeness in a photograph, video, or other digital media in any and all it's publications and social media

I give permission for my child to go with Elevate Bridgeport Staff

Flowers and Bottles

Elevate Bridgeport

Beauty & Brilliance Summer Youth Program

July 7th through August 7th

Monday through Thursday 10am to 2pm

Student's First Name*

Student's Last Name*

Student's email*

Student's Phone Number*

Address*

Parent's Name*

Parent's email*

Parent's Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

What school do you attend?

What grade are you in?*

I hereby grant Elevate Bridgeport permission to use the above names student's likeness in a photograph, video or other digital media in any and all of it's publications and social media

I give permission to my child to go with Elevate Bridgeport Staff

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