Event Interest Registration

First Name: Last Name: Email: Cell Phone: Birth Date: / / Grade: 6 7 8 9 10 11 12 Gender: Male Female Non-binary Prefer not to say Ethnicity: Hispanic/Latino Not Hispanic/Latino How did you hear about the Torch Training? Word of Mouth Website Newsletter School Administrator/Teacher Torch Staff Other School: Areas of Interest (Select all that apply) Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix First Name: Last Name: Email: Cell Phone: Relationship to Student: Is the Parent/Guardian's Home Address the same as the Student's? (If not, please proceed with the questions below) Yes No I accept that I must surrender my phone during the Torch Foundation workshop. Yes I understand that this is a 2 (two) day workshop and 4 (four) week coaching and that my full participation is important Yes Please provide your electronic signature below indicating that you understand and will abide with The Torch Foundation protocol in its entirety.