RED HAWKS RISE - Fall 2023
REGISTRATION FORM

Free for all LMC Fall 2023 math and English co-requisite students
(exclusions may apply to Reconnect students and those that participated in the summer cohort)
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Last Name *
First Name *
Street Address *
City/State *
Zip Code *
Phone number where you can be reached *
LMC Email Address  *
Previous high school district name (or home schooled): *
Year of high school graduation *
Did you attend the Red Hawk Rise Summer Program 2023? *
Are you attending college with assistance from a Reconnect Grant? *
Emergency Contact Name (First & Last) *
Emergency Contact Phone Number *
Dietary Restrictions
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Medical Concerns or Allergies that we should know about (if none, leave blank)

Publicity/Promotional Consent

Portions of these programs may be photographed and/or videotaped for promotional purposes including but not limited to web site, brochures, flyers, newspaper ads/features or promotional/archival videos.  Do we have your permission to use your/your image/name in promotional materials?

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PARTICIPATION RELEASE

I am participating in this program presented by Lake Michigan College (LMC or College).  I release LMC, and the facility where sessions are being held, from any and all liability, damages, or claims whatsoever for any injury or harm that may occur to myself while participating in any activities provided by the College. I agree that I will make no claim or demand against LMC, and the facility where activities are being held, if an injury or accident occurs during an activity provided by LMC, I will look to my own resources, insurance, or assets to pay all medical bills, damages or losses whatsoever if an injury occurs.  The term LMC includes all employees, volunteers, and other staff of LMC participating in the summer programs. I release and will hold harmless LMC personnel who contact emergency providers on my behalf if deemed necessary by staff.
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OPTIONAL STATUS QUESTIONS
The following questions are for the purposes of identifying your needs so that we can best serve you and provide materials to be successful at LMC. Your answers have no effect on your eligibility to participate in this program. This voluntary information will be kept confidential and will not be shared with anyone outside of the program coordinators and staff.
What areas would you like to explore/learn about in getting ready for college? (check all that apply)
What is your Race/Ethnicity?
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What is your gender?
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