No One Is Self Made Teen Workshop Registration Form

Participants Name *

Participants Age *

Parent or Guardians Name *

Parent or Guardians Phone Number *

Parent or Guardians Email Address *

Emergency Contact Name *

Emergency Contact Phone Number *

If You Selected Other Please Add Shirt Size Below

Dietary Restrictions or Special Needs (N/A if not applicable) *

Medical Conditions or Allergies, please specify if you have any medical conditions or allergies we should be aware of. (N/A if not applicable) *

Photography Release: Do you grant permission for EmpowerHood Academy to take photos or videos of the workshop for promotional purposes? *

Yes
No

Special Accommodations: Are there any special accommodations you need during the workshop, such as wheelchair accessibility or extra support? If yes, please specify. (N/A if not applicable) *

Liability and Release Form

I, the undersigned, acknowledge that I have voluntarily registered to participate in the No One Is Self Made Teen Workshop. I understand that there are risks associated with attending this event, including but not limited to accidents, injuries, or unforeseen circumstances.

I assume full responsibility for my own safety and well-being during the workshop. I release and hold harmless EmpowerHood Academy, its officers, directors, employees, agents, and affiliates from any and all liability, claims, demands, or causes of action that I may have for any damages, losses, or injuries sustained by me or my child during the workshop, including but not limited to those caused by negligence, accidents, or other incidents.

I acknowledge that EmpowerHood Academy is not responsible for any medical expenses, lost or stolen property, or other damages that may occur during the workshop.

By signing below, I acknowledge that I have read and understood the terms of this release and hold harmless agreement, and I agree to abide by them.

I have read and understood the terms of this registration form and liability release. By typing my name in the box below, I acknowledge that I am agreeing to the terms and conditions outlined above, and that this electronic signature is equivalent to a handwritten signature.

Parent or Guardian's Signature *

By signing, I acknowledge that I will pick up my teen on time at the end of the workshop, which concludes at 4 pm on September 27th, 2025.

Parent or Guardian Signature *

Date *

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What Teens Will Gain

Why This Workshop Matters

By participating in this workshop, teens will gain valuable skills, knowledge, and confidence to succeed in various aspects of their lives. They'll learn about healthy relationships and how to build strong, positive connections with others. They'll develop leadership skills, including effective communication, decision-making, and problem-solving.

The workshop will also cover conflict resolution strategies, teaching teens how to manage and resolve disputes in a constructive way. The session on navigating encounters will provide teens with essential knowledge on how to interact with law enforcement safely and respectfully.

The workshop will also cover the importance of understanding choices and consequences, helping teens make informed decisions and take responsibility for their actions. Lastly, the discussion on the impact of crime on their future will empower teens with a deeper understanding of the potential consequences of their choices and motivate them to make positive life decisions.

This workshop will be valuable for teens in Greensboro, NC, because it addresses specific challenges and concerns relevant to their community. The focus on conflict resolution, healthy relationships, and navigating police encounters will provide teens with practical skills to manage complex situations and build stronger relationships with their peers, family, and community.

The workshop also emphasizes leadership, public speaking, and making informed choices, which will empower teens to become positive influencers and role models in their community. Given the demographics and socioeconomic context of Greensboro, this workshop will offer a unique opportunity for teens to engage with positive role models, build resilience, and develop essential life skills to overcome challenges and achieve their goals. The workshop's community-focused approach, led by EmpowerHood Academy, will also provide a safe and supportive environment for teens to share their experiences, learn from each other, and develop a sense of belonging and connection to their community.

Expected Impact

What to Expect

The workshop aims to empower teens with essential life skills, confidence, and positive relationships, leading to a ripple effect in the community. We hope to see:

Increased self-esteem and leadership among teens
Improved relationships and conflict resolution skills
Reduced crime and violence
A stronger, more supportive community
Positive role models and a culture of empowerment

By investing in teens, we aim to create a brighter future for Greensboro.

On the day of the workshop, teens can expect:

A welcoming and safe environment
Engaging discussion and activities
Opportunities to build relationships with peers and positive role models
Practical skills and knowledge in areas like conflict resolution, leadership, and healthy relationships
A complimentary shirt and refreshments
A chance to share their thoughts and experiences
A supportive and empowering atmosphere

They should plan to arrive on time, be open to new experiences, and be ready to participate and learn.