2023 Summer Activist Institute Guardian Permission Form

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All applicants must have guardian permission to complete their application for SafeBAE's Summer Activist Institute, to be held on the Southern Maine Community College campus in South Portland, Maine from June 21-24th, 2023. *Please note that spots and funding are extremely limited, so if accepted, each participant and guardian will be required to sign a commitment contract, requiring a reimbursement of costs associated with their participation if they cancel.

> 20 attendees will be chosen competitively from all applicants and will be chaperoned by college student mentors and SafeBAE adult staff.

> Attendance is entirely free and while all travel is not included, travel scholarships will be available.

> Summer Institute graduates will have the opportunity (and guidance) to submit proposals to support their educational activist work in their local school/community and we will rely on their guardians to support them in this ongoing work (with our help).

Legal First and Last Name *

Student's name *

Email *

Cell phone number *

Has your child traveled away from home before? *

Yes

Please share any questions or concerns you have about your child attending the Institute or anything you feel we should know about your child. *

By checking the box you agree that your child may be photographed and filmed during their participation in the Institute. *

YES

Required

By checking the box you agree to help support your child in their continued work during the school year under a grant provided by SafeBAE. *

YES

Required

By typing your name below, you agree that your child has your full permission to attend the 2023 Summer Activist Institute. *

Submit

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