Full Name

First

Last

Age*

School or Organization:*

Parent/Guardian Name (if under 18):*

Parent/Guardian Contact Number:*

Participant Email Address:*

Phone Number:*

Emergency Contact (Name & Phone):*

Why do you want to attend the Dallas Philly Love Tour? (Optional)

Media & Participation Waiver

By registering, I (or my guardian) give permission for the Dallas Philly Love Tour organizers to photograph, film, or interview me during the event for promotional and educational use. I release all organizers, volunteers, and partners from liability for injuries or losses during the event.

Date*

This field should be left blank

Details

Venue

Dallas Philly Love Tour: Stop The Violence Youth Summit

Details

Venue