We are so pleased to inform you that your child has been selected to represent your school/community in the Life Experience Program facilitated by the Blue Ribband Life Staff. The primary purpose of this day, is to meet students where they are in their lives, to build community through tearing down walls of social norms and to build bridges of lasting change in their own lives, as well as in their schools and communities. We use lots of high-energy activities and challenging, eye-opening multi-media presentations. We also employ team-building and hands on activities. Overall, it will be a fun, intense, empowering day for students, teachers, and adult participants.


In completing the form below you agree to the following statements. 

I understand that the event is not required and that his/her participation is voluntary. I further understand that the Blue Ribband Staff, and the sponsoring school/organization, its officers, employees or agents assume no liability either directly or indirectly for injury or accident resulting from or in any way connected with this event. I understand that the Life Experience Program may deal with a wide range of issues such as leadership, self-esteem, teasing, bullying, social injustice, alcohol/drug abuse, violence, racism, and other current issues regarding our young people. I also understand that the program will be fun, eye-opening, emotional, and empowering. I have read the attached letter and have discussed confidentiality with my child/ward and support his/her participation. I further understand that my child/ward may be invited to participate in future Life Experience Programs at his/her school, that members of the print and film media may be present at this event and that my child/ward may be photographed, interviewed or quoted as a participant in this program.


I have carefully read this statement and fully understand its contents. I am aware that this is a release of liability of the Blue Ribband Life Staff and the sponsoring school/organization, its officers, employees or agents.

I give my permission for my child/ward (Student's Name) *
I give my permission for my child/ward (Student's Name)
Check below in place of signature of approval or disapproval. *
Would your student be interested in attending a follow-up leadership seminar? *