Project Rewire Registration

Name

Email Address

Phone

Address

Program of Interest Program of Interest Champions Read (Virtual Book Club) Summer Entrepreneurship Program (Business Building) Chess & Community (Strategy and Community) College Factory (SAT/ACT Prep) 3D CHAMPS (Youth Football)

Date of Birth

Media Release: I give permission for images of my child, captured during Project Rewire to be used solely for promotional purposes and waive any rights or ownership. Media Release: I give permission for images of my child, captured during Project Rewire to be used solely for promotional purposes and waive any rights or ownership.I ConsentI Do Not Consent