The Pivot Event SATURDAY OCTOBER 1, 2022 1:00PM-5:00PM Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Your Birth Date (month, day, year) *Please identify your gender *MaleFemale How will you participate in the Pivot event *youth workerspectatorplayerYour Team Name (required if playing) *Teammate name (required if playing) *FirstLastTeammate name (required if playing) *FirstLastTeammate nameFirstLastTeammate nameFirstLastPlease select the appropriate age and gender of your team *Boys 15 - 17 years oldGirls 15 - 17 years oldMen 18 - 21 years oldWomen 18 - 21 years oldMen 22 - 24 years oldWomen 22 - 24 years oldConsent 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 *ConsentNo ConsentAll participants must Sign: I have read, understand and agree to the policies, notices, and procedures regarding the COVID Pandemic on the registration form. I will contact the LITE coaches immediately if I or someone I may have been in contact with is diagnosed with COVID within 14 days of this 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 SignatureSubmit