Event Registration

Torch Training / Mission Vital

10/12/2024 10:00 AM - 10/13/2024 05:00 PM PT

Teen Information

Enter the information for the person participating in the Torch Training.

First Name: Last Name: Email: Cell Phone: Birth Date: / / Grade Gender: Ethnicity: How did you hear about the Torch Training? School: Areas of Interest (Select all that apply)

Feeling better about myself

Anger management

Improving grades

Improve my relationships

Improve decision making

Improve listening skills

More consistency in taking self-responsibility

Setting goals for myself

Honoring my commitments

Address: City: State: Zip Code: -

Parent/Guardian Information

Enter the information for the Parent/Guardian of the individual attending the Torch Training.

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)

Emergency Contact

Is the Parent/Guardian the emergency contact? (If no, please proceed with the questions below) First Name: Last Name: Email: Cell Phone: Relationship to Student:

Health Information

Enter the health information for the individual participating in the Torch Training.

Does your child have any chronic health problems or physical disabilities? If yes, please describe Has your child had psychological counseling in the last 12 months? If yes, please describe Does your child take medication(s) that we should be aware of? If yes, please describe Does your child have any conditions, learning disabilities, allergies, special needs, or anything else that we should be aware of? If yes, please describe Has your child been hospitalized for an emotional problem within the last six months? (If yes, your child is not eligible to participate) If your child is female, is your child pregnant? If yes, your child is not eligible to participate in the Torch Training at this time. Anything additional we should know about the student?

Training Consent

Our mission at The Torch Foundation is to provide a two-day workshop and follow-up program to increase teens' social/emotional intelligence and leadership skills while gaining confidence in who they are. The workshop is specifically designed to target the areas of self-control, responsibility, integrity, self-awareness, coping and resolution skills, goal setting, and communication. The teens will also learn the value of creating healthy relationships through a safe and engaging environment. These relationships include their families, friends, AND themselves, ultimately setting them up for a successful future.

This signed release grants permission for the teen named below to participate in The Torch Foundation’s personal growth workshop.

Due to local and state regulations, nicotine products, vaping devices, drugs, alcohol, etc., are NOT allowed to be used during the Training and will result in dismissal.

I have read and I understand the description above in regard to the Torch Trainings.

Parent/Guardian Consent and Release

I (Parent/Legal Guardian) agree to allow my child to participate in the Torch training and to abide by the following terms and conditions.

1. I understand that my child has been invited to attend this program, designed to uncover personal behaviors and enable them to modify their approach and response to life events in individual and social settings.

2. I acknowledge that the facilitators, staff, and assistants are not providing psychological therapy and are not responsible for any results the child may receive from the program. I also understand that the program is offered for educational purposes only.

3. I absolve The Torch Foundation, its board of directors, staff, consultants, and volunteers of any liability for issues arising after the program completion.

4. I agree that all communications between participants should be treated as confidential and not disclosed to any non-participant without the written consent of all parties concerned.

5. I understand the workshop is a 2-day program, and full participation is essential.

6. I acknowledge that my child will be required to communicate by phone once a week for one month following the workshop with a vetted and experienced Coach from The Torch Foundation program. These calls are necessary for the completion and award of a certificate.

7. I understand that no cell phones will be allowed during my child's participation in the Torch Foundation workshop on Saturday and Sunday, and teens must surrender their phones while in class.

Please provide your electronic signature below indicating that you understand and agree to this Parent/Guardian Consent and Release for The Torch Foundation in its entirety.

Teen Consent

To be completed by the individual participating in the Torch Training.

I accept that I must surrender my phone during the Torch Foundation workshop. I understand that this is a 2 (two) day workshop and 4 (four) week coaching and that my full participation is important Please provide your electronic signature below indicating that you understand and will abide with The Torch Foundation protocol in its entirety.

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