Programs Registration

Please complete this form if you are interested in registering for one of Pathway's programs.

First Name

Phone

Last Name

Street Address

Street Address Line 2

City

State

Zip Code

Date of Birth

Participant Age

Please list any allergies, medications, etc

If Participant is an Adult:

Household Income ($)

Participant Signature

Date

If Participant is a Youth (please fill out form fields below if you are a parent/guardian of participant):

Full Name of Parent/Guardian

Graduation Year

Parent/Guardian Phone Number

Parent/Guardian Signature

Date

Program Selection:

Waiver & Consent Agreement:

RELEASE, WAIVER OF LIABILITY AND INDEMNIFICATION General Consent: By checking the radio button below, I hereby agree to release and hold harmless Pathway to the Future Learning Center, Inc. DBA Pathway Resource Center, Inc. and its affiliates. MEDIA RELEASE I grant to Pathway Resource Center, Inc. the exclusive right to use photograph/video or film likeness in media and promotional materials. Required

Yes, I have read the above waiver

Opt-In Text Message & Email Communication for Events and Registration Status

By registering for Pathway Resource Center Programming you agree to receive text message and email communications regarding event updates, registration status, and important program information. These notifications are essential for keeping you informed about upcoming events, changes to your registration, and any other relevant updates. You may opt-out of these communications at any time by following the unsubscribe instructions provided in the messages.

Terms and Conditions of Program Enrollment

By enrolling in our program, you agree to adhere to the terms and conditions outlined below. All participants are expected to follow program guidelines, attendance policies, and code of conduct. Failure to comply may result in termination of participation. All fees are non-refundable unless otherwise stated in our cancellation policy. Please review the full terms and conditions before completing your registration. Your enrollment constitutes your acceptance of these terms.

We value your privacy and are committed to safeguarding your contact information and personally identifiable information (PII). Any data you provide during the registration process will be used solely for program-related communications, event updates, and administrative purposes. We do not sell, share, or distribute your information to third parties without your explicit consent, except as required by law. By registering, you consent to the collection and use of your information as outlined in this privacy policy.

Thanks for registering!