LITE Event Registration

We are excited to have you participate in this AMAZING event. We know it is hard to choose what pathway works best for you without trying things out. Here is a great opportunity to see what fits for you. Fill out the information below and begin your journey.

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What event are you registering to attend?IFLY Indoor SkydivingK1 Speed Indoor Go Kart RacingEscape the RoomSandbox Full Body VR GamingMusic Matters Program

Click the dropdown arrow and select the event.

Name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Your Birth Date (month, day, year) *

Please identify your gender *

• Male
• Female
• Non-binary
• Decline to answer

Please identify your race. *

• American Indian or Native Alaskan
• Asian
• Black or African American
• Pacific Islander or Hawaiian
• White or Caucasian

Please check ethnicity. *

• Hispanic origin
• Not Hispanic origin
• Decline to answer

How are you participating in this event? *

• Youth worker
• Enrolled in LITE services
• Not enrolled in LITE service, yet

If not enrolled as a LITE participant, are you with an organization? Please provide the name of the organization below.

Name of person at your organization that will be attending with you *

First

Last

Phone number of person from your organization that will be attending *

Email address of person from your organization that will be attending *

What do you hope to get out of participating in this event?

How did you hear about this event?

Do you have transportation to attend this event?

• Yes
• No
• Riding with my organization

Consent for Promotional Purposes – permission to Leaders In Transformational Education (LITE) to use artwork, writing or pictures/videos taken at this event for the promotional purposes. I understand that refusal to sign this release will not affect delivery of service in any way. I am 18 years old or older/ I am a parent or guardian of a child under 18 years of age *

• Consent
• No Consent

All participants must Sign: I understand and agree to any policies, notices, and procedure regarding transportation provided by my organization and that I must arrive with and leave with the same transporter. At no time will I leave an event with an unauthorized person. I / my child will stay with the group while at the event and be at designated pick up and drop off locations at the assigned time. I understand and do not hold any representative of (LITE) responsible for accidents or injuries in the event an unforeseen incident occurs and that me / my child agree to abide by the rules set for transporting. In the event the rules are not abide by, LITE may refuse to allow me / my child from participating in future off-site events. LITE will only provide transportation for LITE clients that are registered and active in LITE programming, If you are not a registered and active LITE client you / your child must secure your own transportation. If offered I agree to the above and give permission for me/ my child to take the transportation offered to the above mentioned event *

Clear Signature

I/my child does not have a medical condition that I am aware of that prevents me / my child from participating in this activity. I agree to hold Leaders In Transformational Education (LITE) and any of its officers, employees, or volunteers free from any and all liability and waive all claims of damages or recompense for any accident, injury or disability to me or my property arising out of or connected with my participation in this activity/outing. I also authorize the Chief Executive Officer of (LITE), or duly designated representative, to secure the necessary medical, hospital and surgical attention, in the event of illness or physical injury to me/ my child during participation in this activity. By providing your signature below you have read and agree to the statement above. *

Clear Signature

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