YVU Registration Form

I. Personal Information

First Name

Middle Name

Last Name

Birthday

Age

Street Address

City

Region/State/Province

Postal / Zip code

Phone

Parent(s) / Guardian(s)

Church Name

Pastor Name

Parent/ Guardian Phone

I hereby certify the my son/daugter has my permission to participate in Your Voice Unleashed. To the best of my knowledge, he/she is physically able to participate in such activitiy and is not suffering fom any disease or injury that will caue harm to him/her or others. I agree and do herby waive and release all claimes against Unity Unlimited, Inc., JuneteenthFTW or any person engaged in the acivity and agree to hold them harmless from any and all liability relating to my son/daughter for any personal injury or illness that may be suffered or any loss of property that may occor.

Parent/Guardian Signature

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YVU Registration Form

I. Personal Information

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