STRONG FUTURE REGISTRATION FORM vada.gov

[Pages:2]STRONG FUTURE

REGISTRATION FORM

Batteries Included Teen Council is an out of school time program that provides teens with a variety of activities which focuses on leadership, education, workforce development, college preparation, civic engagement and healthy living. The Batteries Included program is year-round providing organized special events, retreats, college tours, all FREE of charge. Each Batteries Included Teen Council is assigned an adult advisor who is present at all teen council meetings and special activities. The adult advisors are in place to provide guidance and advice to council members. Check with your teen's Batteries Included site for meeting dates and times.

For more information call (702) 229-4075 or visit batteriesincluded

BATTERIES INCLUDED TEEN COUNCIL REGISTRATION FORM

We are always looking for new members to join Teen Council.

Name:_________________________________________________________________ Date of Birth:_____________________________________________________

Address:__________________________________________________________________________________________________ Zip Code:_____________________

Home Phone Number:____________________________________________________ Cell Phone:_______________________________________________________

Grade Level_______________________ E-mail:_______________________________________________________________________________________________

Graduation Date:______________________________ School Attending:____________________________________________________________________________

For ourselves and/or on behalf of our child named below, our heirs, executors and administrators, we hereby expressly and forever waive and release the city of Las Vegas, and all their respective officers, employees, agents or representatives from any and all personal injuries or damages sustained, incurred, arising from, or connected with the program or activity described herein, including classes, tournaments and/or special events, and all activities related to, or in connection with, said activity of our child.

Parent/Guardian Name:_______________________________________________________________________________________

Parent/Guardian Signature:____________________________________________________________________________________ Date:________________________

Phone Number:__________________________________________________________ Cell Phone:_______________________________________________________

E-mail:__________________________________________________________________________________________________________________________________

TTY#

Participant Signature:________________________________________________________________________________________ Date:_________________

Indicate the Council you would like to attend. You will be contacted on the meeting dates and times.____________________________________________________________________________________________________________________________

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STRONG FUTURE

TEEN COUNCIL

Bonanza High School Teen Council Canyon Springs High School Teen Council Cheyenne High School Cimarron Memorial High School Teen Council Cimarron Rose Community Center Doolittle Community Center Teen Council East Las Vegas Community Center Teen Council Legacy High School Teen Council Las Vegas Academy High School Teen Council Mirabelli Community Center Teen Council Peterson Academic Center Rancho High School Teen Council Stupak Community Center Teen Council Valley High School Teen Council Veterans Memorial Leisure Center West Preparatory High School Teen Council Western High School Teen Council

LOCATIONS

6665 Del Rey Ave. 350 E. Alexander Road 3200 W. Alexander Road Buffalo Drive & Tenaya Way Durango Drive & Ann Road J Street & Lake Mead Boulevard N. Eastern & Stewart avenues W. Deer Springs Way & 215 Beltway North

315 S. 7th St. Jones Boulevard & U.S. 95 10250 W. Centennial Pkwy.

1900 E. Searles Ave. Boston Avenue & Las Vegas Boulevard

2839 Burnham Ave. 101 Pavilion Center Drive 2050 Sapphire Stone Ave. 4601 W. Bonanza Road

CONTACT

(702) 799-4000 (702) 334-3425 (702) 799-4830 (702) 578-2739 (702) 229-1607 (702) 229-6374 (702) 229-6242 (702) 799-1777 (702) 799-7800 (702) 229-6359 (702) 799-6610 (702) 229-2330 (702) 229-2488 (702) 799-5450 (702) 229-1100 (702) 372-9887 (702) 229-2330

YD-0043-08-17 MD

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