Flip The Script Registration & Waiver Form Complete this form to register and agree to the program's terms and conditions. Participant Information Full Name* First NameMiddle NameLast Name Date of Birth* -Month -DayYearDate Age* Gender* MaleFemale Phone Number* Please enter a valid phone number.Format: (000) 000-0000. Email Address* example@example.com Home Address* Street Address Street Address Line 2CityState / ProvincePostal / Zip Code Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country City* State* ZIP Code* School Name Current Grade Level* Please Select Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade College/University Not Applicable Emergency Contact Name* First NameMiddle NameLast Name Emergency Contact Relationship* Emergency Contact Phone Number* Please enter a valid phone number.Format: (000) 000-0000. Parent/Guardian Information Parent/Guardian Full Name* First NameMiddle NameLast Name Parent/Guardian Phone Number* Please enter a valid phone number.Format: (000) 000-0000. Parent/Guardian Email Address* example@example.com Parent/Guardian Signature* Entrepreneurship Interests Entrepreneurship Interests* Financial LiteracyStarting a BusinessClothing BrandReal EstateE-CommerceContent CreationPublic SpeakingMarketing & BrandingLeadership DevelopmentNonprofit DevelopmentNetworkingLearning How to Build Income StreamsOther What business ideas or goals are you interested in pursuing?* Program Expectations Program Acknowledgment* I understand this is a leadership and entrepreneurship-based program.I understand consistent participation and respectful behavior are expected.I understand opportunities and incentives may depend on attendance and participation. Participation Expectations Acknowledgment* I understand this is a leadership and entrepreneurship-based program.I understand consistent participation and respectful behavior are expected.I understand opportunities and incentives may depend on attendance and participation. Program Terms Acknowledgment* I understand this is a leadership and entrepreneurship-based program.I understand consistent participation and respectful behavior are expected.I understand opportunities and incentives may depend on attendance and participation. Liability Waiver & Media Release I have read and agree to the waiver and release terms.* I have read and agree to the waiver and release terms. Participant Signature* Parent/Guardian Signature Communication Opt-In I agree to receive text messages, updates, reminders, opportunities, and program information from Be The Proof Foundation.* Opt-in I agree to receive emails, newsletters, updates, opportunities, and announcements from Be The Proof Foundation.* Opt-in Submit RegistrationSubmit Registration Should be Empty:
