Project TRIUMPH Registration Form
Project TRIUMPH is a grant-funded initiative implemented by the Centre for Homeownership and Economic Development.  TRIUMPH is an acronym for "Training and Resources To Improve Understanding of Mental and Physical Health".  Through Project TRIUMPH, the Centre intends to impact the needs of youth (ages 13-24) across Durham County and their families.  This enrollment form grants permission for you (18 years and older) or your child to participate in Project TRIUMPH programming 
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Participant First Name *
Participant Last Name *
Participant Age *
Contact Phone Number *
Contact Email Address *
Address (include City, State, Zip Code) *
Ethnicity *
Areas of Interest: To support the planning process of Project TRIUMPH activities, please indicate areas of interest. (You may select more than one option.) *
Required
Some Project TRIUMPH activities will include meals.  Please list any food allergies.   *
Please list any disabilities, learning impairments, restrictions or circumstances that we should be aware of. *
I hereby give my consent for myself or my child to be photographed and/or videotaped for use by Project TRIUMPH in the production of any and all media for marketing purposes. This may include use of my child’s image on video materials produced for broadcast circulation as well as for the organization’s printed materials, website and/or social networking tools such as Facebook.
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Emergency Contact Information:  I authorize the following person(s) to be contacted and give my permission to turn my child over to this person(s) in case of an emergency and I cannot be reached.  (PLEASE INCLUDE NAME, RELATIONSHIP TO CHILD, AND PHONE.)

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By providing my name below, I certify that the information given above is complete and accurate to the best of my knowledge.  I authorize myself or my child to participate in a Project TRIUMPH cohort.  I assume all risks associated with participating and release the Centre for Homeownership from any and all liability, present or future, resulting from or arising out of this project. *
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