Student Registration Form - THE DIKACHI CARE INITIATIVE (TDI)

Coal City Student Boot Camp Registration Form

Part A: Student’s Bio

Name of Student

School

Class

Gender

Age

Phone Number

Email Address

Address

Nationality

State *

Local Government Area*

Favourite Subject

Favourite Teacher

Hobbies

Mentor

Career Choice

Any Special Need

Briefly write your reasons for entering the competition. (Maximum of fifty words)

Part B: Parent/Guardian’s Bio

Name

Phone Number

Occupation

Address

State *

Local Government Area*

Consent

Medical Information
Please note that my child/ward has the following medical conditions/allergies: [List medical conditions/allergies, if applicable]

Emergency Contact Name
In case of an emergency, please contact:

Emergency Name

Emergency Contact Phone

Alternate Emergency Name

Alternate Emergency Contact Phone

Dear Organizers,

I hereby grant permission for my child/ward to participate in the Coal City Student Boot Camp. I understand that this competition is conducted for educational purposes and will adhere to the rules and guidelines of the competition
I grant permission for the organizer to:
- Use my child/ward's image, voice, or work for promotional purposes
- Administer first aid or medical treatment, if necessary

Release of Liability:
I release and hold harmless the Competition Organizer, its officers, directors, employees, and agents from any claims, damages, or expenses arising from my child/ward's participation in this competition.

Verification:
I have reviewed and understood the competition rules, guidelines, and accommodation requirements.

Contact Information:
If you require additional information or clarification, please reach out to the aforementioned contact details.