Partner Bundle

Student First Name *

Student Last Name *

Student Gender *
MaleFemaleOther

Student Email *

Student Phone Number

Student Grade in 2021-2022 (the coming school year) *

Student School & State *

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Number *

Second Student First Name *

Second Student Last Name *

Second Student Gender *
MaleFemaleOther

Second Student Email *

Second Student Phone Number

Second Student Grade in 2021-2022 (the coming school year) *

Second Student School & State *

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Number *

Previous Debate/Public Speaking Experience (N/A if none) *

In the space below, please include whether your child has attended any previous debate/public speaking camps. If they've already had experience on a speech/debate team, please elaborate what event they participated in, as well as how long they've participated for. Feel free to include any other information about their debate/public speaking experience as well! If your child has not had any previous experience, simply write N/A.

How did you hear about MPower4Change Debate? *
From a friendWeChatWhatsAppInstagramGoogleFacebookRedditOther

Terms and Conditions

1. I grant permission for MPower4Change and its affiliates to take and use any pictures, videos, or other likenesses of my child for advertising and publicity purposes without compensation or prior notice.

2. I understand that MPower4Change and its affiliates reserve the right to remove any student that exhibits behavior deemed inappropriate or dangerous by the staff, with no refunds made.

3. I accept that MPower4Change and its affiliates are not liable for any injury/harm that occurs to students or any dangerous/problematic behavior exhibited by students before, during, or after their camp sessions.

Accept Terms and Conditions *
I accept all 3 termsI accept terms 2 & 3, but not term 1

Any special requests?