PARTICIPANT INFORMATION & CONSENT FORM

#SacTownYouthNights are fun, engaging events where young people come together to learn, connect, and grow. These nights are all about building community, exploring new ideas, and having a great time in a supportive environment. This program is made possible through the #SacTownYouthNights 2025 grant, funded by the City of Sacramento.

As part of our commitment to this grant, please complete the following application to ensure we are meeting our goals and making a real impact. These forms help us track participation, share success stories, and continue bringing valuable opportunities to youth in our community.

Thank you for being part of this journey—your voice, your ideas, and your future matter! 🎉✨

Participant Name

First Name

Last Name

Email

Check all the events you plan to attend. You’ll receive $50 each time you attend three events.

You can leave anytime, but we encourage you to stay for the full three hours to get the most out of the experience! Address: 1610 R St Suite 300, Sacramento, CA 95811

Saturday, March 15

Saturday, March 22

Saturday March 29

What year were you born?

Zip Code

Sex

Race/Ethnicity

Emergency Contact Name

Emergency Contact Phone Number:

Behavioral Conduct Agreement:

As a participant in the program, I agree to adhere to the following guidelines: 1. Treat all participants, staff, and guests with respect. 2. Engage positively in all activities and avoid disruptive behavior. 3. Respect the space, equipment, and facilities provided. 4. Follow all safety instructions and guidelines provided by program staff. 5. Understand that any violation of this agreement may result in removal from the program.

Agree

Photo & Video Release:

I, grant permission to HUMANBULB to take and use photographs/videos of me for promotional, educational, and informational purposes, including but not limited to: - Website and social media platforms - Promotional materials such as brochures, flyers, and presentations - News media and educational publications I understand that these materials may be used without further notification or compensation. I release HUMANBULB from any claims arising from the use of these images/videos.

Agree

Digital Signature: Please type your full name as your electronic signature.

Any Additional Comments?