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Youth Summit Registration 2021

  1. Youth Summit 2021 Registration
    An event in partnership with Cedar Hill Police & Cedar Hill ISD Police Departments.
  2. First & Last Name
  3. First & Last Name
  4. Business Name, Address & Phone
  5. Name, Relationship & Phone Number
  6. CHILD SIGNATURE:*
    CODE OF CONDUCT: Participants will be responsible for their actions, language, and behaviors. I will be respectful of others and follow the direction of all staff members. By checking the "I agree" box below, the child agrees to adhere to the above Code of Conduct of the Youth Summit.
  7. PARENT SIGNATURE:*
    MEDICAL: I certify my child's participation is in this event is voluntary and I consent to receive emergency medical treatment in the event of injury, accident, and/or any illness during this activity.
  8. CONTENT ACKNOWLEDGEMENT:*
    Topics of education are age appropriate and will contain material applicable to teen awareness and prevention programs involving drugs, alcohol, and social media safety and I agree to their involvement.
  9. PHOTO/VIDEO RELEASE:
    Child can be photographed or recorded and agrees to allow the photos or videos to be used for marketing purposes of the event.
  10. T-Shirt Size (Adult Sizing):*
  11. TRANSPORTATION TO EVENT:*
  12. QUESTIONS?
    Contact Office Rhonda Knott at 972-291-5181 x 2153 or rhonda.knott@cedarhilltx.com.
  13. We will be following the recommended CDC guidelines to prevent the spread of COVID:
  14. School systems must require staff to self-screen for COVID-19 symptoms before coming onto campus each day. Symptoms are listed below. Clean and disinfect frequently touched surfaces within the school regularly. Use of shared objects will be limited when possible. If shared objects are used, students will wash hands or use hand sanitizer, masks will be utilized, and social distancing will be in place.
  15. Parents must ensure they do not send a child to Youth Summit if the child has COVID-19 symptoms: * Feel feverish or a measured temperature greater than 100° Fahrenheit * Loss of taste or smell * Cough or difficulty breathing * Shortness of breath * Fatigue * Headache * Chills * Sore throat
  16. Leave This Blank:

  17. This field is not part of the form submission.