Lafayette Peer Empowerment Project (LPEP) High School Registration Form 2021-22                            
High School LPEP is a 9-12th grade afterschool and summer program held at the ArtsHub (420 Courtney Way, Lafayette), giving a unique opportunity for youth to use their talents for creating positive Social Change. Participants establish focus groups led by expert mentors, honing in on topics that speak to their passions.

LPEP supports Lafayette  students aiming to stay in school, pursue post-secondary education and secure employment. Participants develop essential skills in leadership, communication and self-advocacy.

High School LPEP meets every Monday & Wednesday from Sept 20-Dec 8 between 4-5:30pm.

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Name: *
Address: *
Phone  Number *
Email *
School and grade level *
Preferred Pronoun (He/She/They): *
Ethnicity (optional)
Does your family qualify for free or reduced lunch (optional)?
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Do you want your child to be picked up and taken to the ArtsHub by Lafayette Free Ride?
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Emergency Contact Name and phone number: *
Food Allergies/Medical Conditions: *
I give my child/children permission to participate in Art for Social Change and I hereby release and forever discharge and hold harmless the Lafayette Empowerment Center and its staff members, volunteers, and community partners from any and all liability, claims, and demands of whatever kind or nature, which arise or may hereafter arise from the below named minor child’s participation in this program. I also give the Lafayette Empowerment Center permission to photograph my child for outreach and reporting purposes.                                                                  By submitting this form I am agreeing to the above statement.                                                                    Guardian Name: *
Please let us know if you have any questions?                                                                           stephanie@lafayetteempowerment.org  or 720-204-8466
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