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E Cube Registration Form

Participant's information

Participant's First Name *

Participant's Last Name *

Participant's Age

Participant's Gender

Guardian's Email Address

Guardian's Phone Number

Guardian's First Name

Guardian's Last Name

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

Medical Information

Does the participant have any allergies?MaybeYesNo

Please specify allergies

Does the participant have any medical conditions we should be aware of? *MaybeYesNo

Is the participant currently taking any medications?MaybeYesNo

Talent and Interests

What are the participant’s main talents or interests?

Has the participant previously attended any talent development programs?MaybeYesNo

Additional Information

How did you hear about the Boys Lead Foundation boot camp?Friends & FamilySocial MediaOther

Any additional comments or information we should know about the participant?

Consent and Permissions

Do you consent to the participant receiving necessary medical treatment in case of an emergency?YesNo

Do you give permission for the participant to be photographed or recorded during the boot camp for promotional purposes?YesNo

Consent *

I confirm that all the information provided is accurate to the best of my knowledge.

Yes, I agree with the privacy policy and terms and conditions.

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